Patients with psoriasis who are prescribed biologic therapies are less likely to have a history of cardiovascular disease and psychiatric illnesses compared with patients who are not prescribed biologic agents, according to study results published in the Journal of the American Academy of Dermatology.
In this retrospective cohort study, investigators analyzed the OptumInsights Electronic Health Record database, which contains de-identified patient-level data on the healthcare encounters of 81 million individuals. The participants selected were diagnosed with psoriasis according to International Classification of Diseases, Ninth Revision or International Classification of Diseases, 10th Revision codes. Researchers performed separate analyses using 2 datasets: one containing every patient with psoriasis (n = 262,552) and a 10% random sample of the full OptumInsights Electronic Health Record dataset (n = 5,858,998), both of which contained patient information from January 1, 2007, to June 30, 2017. Investigators evaluated drug exposure to biologic agents adalimumab, etanercept, ustekinumab, ixekizumab, and secukinumab. They assessed methotrexate as a comparison agent to control for confounding by disease severity. The outcomes of interest were any psychiatric illness, depression, psychosis, bipolar disease, suicide, or suicidal ideation.
Compared with individuals without psoriasis, patients with psoriasis were significantly more likely to have a history of cardiovascular or psychiatric illnesses. Individuals with psoriasis who were prescribed a biologic agent were significantly less likely to develop a psychiatric illness when compared with patients who had not been prescribed a biologic agent (hazard ratio 0.52 [95% CI, 0.51-0.53]; P <.0001). These individuals were also less likely than persons prescribed methotrexate to have a history of myocardial infarction, cerebrovascular accident, or chronic obstructive pulmonary disease. Patients prescribed biologics were more likely to be younger and white and were less likely to have a history of any of the medical illnesses of interest.
This study has limitations inherent in a retrospective cohort design: most notably, the potential for selection bias. Forms of information bias may have also affected this study because of differences in medical insurance systems by state.
The researchers acknowledged it may be possible that the use of biologic therapy has a direct influence on the development of psychiatric illnesses in patients with psoriasis, but in this study, biologic treatment selection that favors healthier patients is likely associated with the researchers’ failure to find an increased risk for psychiatric outcomes. It may further be possible that physicians are selecting specific patients to receive biologic therapy to minimize adverse events.
Several authors declared affiliations with the pharmaceutical industry. Please see the reference for the full list of disclosures.
Margolis DJ, Shin D, Noe MH, et al. Biologic therapy prescribing is not associated with psychiatric illness: an electronic medical records cohort study [published online May 2, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.04.055