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The risk of treated anxiety and treated depression among patients with psoriasis and PsA treated with apremilast compared to biologics, DMARDs and corticosteroids: a cohort study in the United States MarketScan database

C Vasilakis-Scaramozza, R Persson, K W Hagberg, S Jick
Journal of the European Academy of Dermatology and Venereology: JEADV 2020 January 25
31981426

BACKGROUND: Anxiety and depression are common among psoriasis and psoriatic arthritis (PsA) patients, but rates may differ by treatment OBJECTIVE: To quantify the risk of incident treated anxiety, depression and mixed anxiety+depression in users of apremilast compared to users of other treatments for psoriasis and PsA.

METHODS: We conducted two separate cohort studies of psoriasis and PsA patients treated with apremilast, tumor necrosis factor inhibitor biologics, interleukin-17, -23 or -12/23 inhibitor biologics, conventional DMARDs, or systemic corticosteroids in the United States MarketScan database. Cohort entry was date of first study drug after March 21, 2014. We identified cases who had a depression and/or anxiety diagnosis with a prescription for antidepressant/antianxiety medication within 30 days of the diagnosis code. We calculated incidence rates (IRs) and incidence rate ratios with 95% confidence intervals (CIs) for treated anxiety, treated depression, and treated anxiety+depression per 1000 patient-years (PY) among patients.

RESULTS: Among the psoriasis cohort, IRs for each outcome were similar between exposure categories and highest among users of systemic corticosteroids alone. IRs (95%CI) for apremilast alone were 9.2 (6.6-12.5), 4.6 (2.8-7.1) and 4.6 (2.8-7.1) per 1000 PY for treated anxiety, treated depression, and treated anxiety+depression, respectively. In the PsA cohort, the rate of anxiety was highest among users of apremilast alone; rates of depression and anxiety+depression were similar for apremilast compared with other PsA treatments. IRs for each outcome were also high for users of corticosteroids in both the psoriasis and PsA cohorts.

CONCLUSIONS: Among patients with psoriasis, users of apremilast had similar rates of anxiety and depression as users of other non-corticosteroid systemic psoriasis treatments. Among PsA patients, users of apremilast had similar rates of depression and anxiety+depression compared to users of other systemic non-corticosteroid PsA drugs; however, the rate of anxiety was slightly higher.

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