Adalimumab Improves QoL, Psychological Functioning in Psoriasis

Psoriasis on elbow
Psoriasis on elbow
Successful treatment of the dermatologic symptoms of psoriasis with adalimumab also positively affects a patients’ quality of life and psychological functioning.

Along with improvements in cutaneous disease, patients with psoriasis who were treated with adalimumab can see significant improvements in quality of life (QoL) and mental and physical well-being, according to a recent study published in the Journal of Dermatological Treatment.

British researchers evaluated the real-world impact of adalimumab in disease-related QoL, body image, psychological well-being, and sexual functioning in individuals with moderate-to-severe psoriasis. Patients who fulfilled the National Institute for Health and Clinical Excellence criteria, such as moderate-to-severe psoriasis with a total Psoriasis Area and Severity Index (PASI) of ≥10 and a Dermatology Life Quality Index (DLQI) ≥10, and who were non-responders to, intolerant of, or contraindicated to standard treatments were requested to answer a questionnaire. Those who were not biologic-naïve, who refused consent, or were unable or unwilling to answer the questionnaire were excluded.

Patients (n=143) completed the questionnaires at baseline, at 4 weeks, 16 weeks, and 6 months after starting adalimumab. The primary objective was to measure the changes from baseline in DLQI 16 weeks after starting adalimumab. Secondary objectives were changes from baseline in DLQI, Short-Form-12 (SF-12) Health Survey, Self-Administered Psoriasis Area and Severity Index, Hospital Anxiety and Depression Scale (HADS), Female Sexual Function Index or International Index of Erectile Function, Cutaneous Body Image scale, and PASI at 4 weeks, 16 weeks, and 6 months post-initiation.

A total of 85% (114/134) of patients at baseline, 16% (13/80) at 16 weeks, and 12% (12/100) at 6 months had a DLQI ≥11 (skin disease has a “very” or “extremely” large effect on patient’s life). The proportion of patients with a score of 0 (“skin disease has no effect on personal relationships”) increased from 22% at baseline to 48% at 4 weeks, 75% at 16 weeks, and 81% at 6 months. In patients with paired scores, 42% (10/24) of patients had a ≥75% reduction in PASI from baseline at 4 weeks, 73% (58/80) at 16 weeks, and 81% (72/89) at 6 months.

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Mean HADS-anxiety and HADS depression scores improved significantly from baseline at 4 weeks (P <.05), 16 weeks (P <.001), and 6 months (P <.001). Mean Cutaneous Body Image scores improved significantly from baseline at 16 weeks (P <.01) and 6 months (P <.001). Mean SF-12-physical health and SF-12-mental health scores improved significantly from baseline at 16 weeks (P <.001 [physical health]; P <.01 [mental health]) and 6 months (P <.001). Mean Female Sexual Function Index score improved significantly from baseline at 6 months (P <.01). Researchers observed no significant differences in sexual function in men.

Limitations of the study include the potential for bias, introduced by the requirement for patient consent, and the necessity to speak, read, and understand English. This was minimized by the study design, as the comparisons were not between groups, but between time periods in the same patient. Also, there was no control group and possible confounding factors (eg, concomitant medications) were not captured.

Researchers concluded that adalimumab improves psychological and psychiatric (but not psycho-sexual) comorbidities while improving cutaneous disease in patients with moderate-to-severe psoriasis.

Disclosure: Multiple authors declare associations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Leman J, Walton S, Layton AM, et al. The real world impact of adalimumab on quality of life and the physical and psychological effects of moderate-to-severe psoriasis: a UK prospective, multicenter, observational study [published online March 21, 2019]. J Dermatolog Treat. doi:10.1080/09546634.2019.1592096