Comparison of mental health outcomes among adults with psoriasis on biologic versus oral therapies: a population-based study

Abstract

Purpose: We sought to compare the impact of biologic versus oral therapies on mental health outcomes among adult U.S. residents with moderate-to-severe psoriasis.

Methods: We performed a nationwide, cross-sectional study comparing 2,303,534 (weighted) adults with moderate-to-severe psoriasis on biologic versus oral therapies and their associated mental health outcomes using the 2003–2015 Medical Expenditure Panel Survey (MEPS). Mental health outcomes were measured with the Kessler 6 (K6), a validated measure of psychological distress, and Patient Health Questionnaire 2 (PHQ2), a screening tool for depression.

Results: The mean K6 score for residents on biologic therapies was significantly lower than that of residents on oral therapies (2.72 [95% CI: 2.27–3.17] versus 3.70 [95% CI: 3.27–4.12]; p < .001). The mean PHQ2 score for residents on biologic therapies was also significantly lower than that of residents on oral therapies (0.540 [95% CI: 0.390–0.690] versus 0.890 [95% CI: 0.749–1.031]; p < .001). Based on adjusted multivariable linear regression models, biologic therapy was associated with significant reductions in K6 (p < .001) and PHQ2 (p = .016) scores compared to oral therapy.

Conclusions: Therapeutic choices for psoriasis impact mental health outcomes. Biologic therapy is associated with reductions in psychological distress and depression as compared to oral therapy in the U.S. adult moderate-to-severe psoriasis population.

Keywords:

• Psoriasis
• mental health
• psychological distress
• depression

Acknowledgments

This study was conducted with publicly available, de-identified data from the Agency for Healthcare Research and Quality’s (AHRQ) MEPS.

Disclosure statement

Nicole Salame and Nazanin Ehsani-Chimeh declare that they have no conflict of interest. April W. Armstrong has no relevant financial conflict of interest; other disclosures include her role as an investigator, consultant, advisor, and/or speaker to AbbVie, Janssen, Lilly, Novartis, Sanofi, Regeneron, Leo, Science 37, Modmed, Pfizer, Ortho Dermatologics, and Modernizing Medicine.

Data availability statement

The data that support the findings of this study are available in the Agency for Healthcare Research and Quality (AHRQ) MEPS Data Files at https://meps.ahrq.gov/mepsweb/data_stats/download_data_files.jsp. These data were derived from the following resources available in the public domain:

Household Component Medical Conditions file:

https://meps.ahrq.gov/mepsweb/data_stats/download_data_files_results.jsp?cboDataYear=All&cboDataTypeY=1%2CHousehold+Full+Year+File&buttonYearandDataType=Search&cboPufNumber=All&SearchTitle=Medical+Conditions

Household Component Prescribed Medicines Event file:

https://meps.ahrq.gov/mepsweb/data_stats/download_data_files_results.jsp?cboDataYear=All&cboDataTypeY =2%2CHousehold+Event+File&buttonYearandDataType=Search&cboPufNumber=All&SearchTitle=Prescribed+Medicines

Household Component Full-Year Consolidated Data file:

https://meps.ahrq.gov/mepsweb/data_stats/download_data_files_results.jsp?cboDataYear=All&cboDataTypeY =1%2CHousehold+Full+Year+File&buttonYearandDataType=Search&cboPufNumber=All&SearchTitle=Consolidated+Data