A real-world, cohort study finds popular skin rash drugs also boost moods.
A new study found that systemic treatment of atopic dermatitis (AD) not only relieves skin symptoms, but also can improve the patient’s emotional well-being, according to a prospective, real-world, clinical cohort study presented at the annual meeting of the International Society of Atopic Dermatitis.1
The study was led by investigator Lina Ivert, MD, PhD, of the dermatology and venereology unit at the Karolinska Institutet, Stockholm. It assessed data from SwedAD, a newly launched web-based Swedish national registry of patients with AD on systemic treatment between June 2017 and August 2021.
Researchers studied patients for 6 and 12 months for the primary outcome of depressive symptoms using the Montgomery–Åsberg Depression Rating Scale–self-report (MADRS-S). This scale consists of 9 items assessing patients' mood, feelings of unease, sleep, appetite, ability to concentrate, initiative, emotional involvement, pessimism and zest for life. Each item is scored between 0 and 3, with three intermediate levels (0.5, 1.5, 2.5).
At baseline, 120 patients (median age, 39 years; 57.5% men) were started on dupilumab (n = 91), methotrexate (n=26), or cyclosporin (n=3). Although almost half had no depression at baseline, mild depression was present in 29.2% of patients, with moderate and severe depression in 20% and 4.2%, respectively.
Among 59 patients with 6-month follow-up data (48 on dupilumab, 10 on methotrexate, and 1 on cyclosporin), all 9 depressive symptoms in MADRS-S improved significantly, with the top benefit being better sleep (from a median of 3 points to a median of 1 point). Similarly, overall MADRS-S scores improved (from a median of 14 points to a median of 5; P < .001), as did the Eczema Area and Severity Index (EASI) scores (from a median of 20.5 to 2), The Patient Oriented Eczema Measure (POEM) scores (from a median of 22 to 6), The Dermatology Life Quality Index (DLQI)(from a median of 15 to 3), and pruritis scores (from a median of 7.1 to 1.8; all P < .001).
The analysis also found a strong correlation between the MADRS-S score and all secondary outcomes (P < .001 for all). All these improvements remained significant among the 36 patients with 12-month follow-up data. Ivert added that 3 patients with severe suicide ideation at baseline improved their MADR-S suicide item to less than 2 points.
1. International Society of Atopic Dermatitis (ISAD) 2022: Abstract OL.18, Presented October 18, 2022.