Ferrucci Silvia Mariel, Tavecchio Simona, Ceresa Alessandro, Angileri Luisa, Berti Emilio, Marzano Angelo Valerio, Buoli Massimiliano
Dermatology Section, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.
J Clin Med. 2024 Mar 29;13(7):1980. doi: 10.3390/jcm13071980.
: Atopic Dermatitis (AD) is a prevalent inflammatory skin disease whose course is often complicated by the presence of concomitant anxiety and depressive disorders. Dupilumab has been demonstrated to be largely effective in AD. The aims of the present study were to (1) to verify the effectiveness of 2-year dupilumab treatment on the depressive and anxiety symptoms of patients affected by AD and (2) to identify predictors of the persistence of psychiatric symptoms despite maintenance treatment with dupilumab. : A total of 331 patients with severe AD were assessed at baseline and at different times over 2 years by a large set of rating scales, including the Eczema Area and Severity Index (EASI), the Hospital Anxiety and Depression Scale (HADS), and the Dermatology Life Quality Index (DLQI). Paired sample -tests were performed to verify the effectiveness of dupilumab on the severity of AD and mental health items. Two binary logistic regression models were then used to identify the predictors of the persistence of clinically significant depression and anxiety, defined by a score ≥ 8 on each sub-scale of the HADS. : After 2 years of treatment with dupilumab, the patients benefited, showing a significant improvement in both the dermatological disease and comorbid depression/anxiety ( < 0.001 for all scales). Overall, 17.5% and 13% of patients, respectively, reported residual depressive and anxiety symptoms after the 2-year treatment with dupilumab. The baseline predictors of the persistence of clinically significant depressive symptoms after the 2-year treatment with dupilumab were found to be a higher body mass index (BMI) ( = 0.012), a lower impact of dermatological disease on quality of life ( = 0.015), and more severe depressive symptoms ( < 0.01), while for anxiety, the only predictor was found to be female gender ( = 0.03). : Using a multidisciplinary approach, at baseline, dermatologists should more closely monitor patients who are at a greater risk of maintaining residual psychiatric symptoms despite therapy, such as those with more severe depressive symptoms and those who are overweight.
特应性皮炎（AD）是一种常见的炎症性皮肤病，其病程常因伴有焦虑和抑郁障碍而复杂化。度普利尤单抗已被证明在AD治疗中具有显著疗效。本研究的目的是：（1）验证度普利尤单抗两年治疗对AD患者抑郁和焦虑症状的有效性；（2）确定在接受度普利尤单抗维持治疗后仍存在精神症状的预测因素。共有331例重度AD患者在基线时以及2年中的不同时间通过一系列评定量表进行评估，这些量表包括湿疹面积和严重程度指数（EASI）、医院焦虑抑郁量表（HADS）以及皮肤病生活质量指数（DLQI）。采用配对样本检验来验证度普利尤单抗对AD严重程度和心理健康项目的有效性。然后使用两个二元逻辑回归模型来确定临床显著抑郁和焦虑持续存在的预测因素，临床显著抑郁和焦虑的定义为HADS各子量表得分≥8分。度普利尤单抗治疗2年后，患者病情得到改善，皮肤病及合并的抑郁/焦虑症状均有显著改善（所有量表P<0.001）。总体而言，度普利尤单抗治疗2年后，分别有17.5%和13%的患者报告仍有残留的抑郁和焦虑症状。度普利尤单抗治疗2年后仍存在临床显著抑郁症状的基线预测因素为较高的体重指数（BMI）（P = 0.012）、皮肤病对生活质量的较低影响（P = 0.015）以及更严重的抑郁症状（P<0.01），而对于焦虑症状，唯一的预测因素是女性（P = 0.03）。采用多学科方法，在基线时，皮肤科医生应更密切地监测那些尽管接受治疗但仍有较高维持残留精神症状风险的患者，如那些有更严重抑郁症状的患者和超重患者。
