title: Effect of biologics on depressive symptoms in patients with psoriasis: a systematic review.
abstract: BACKGROUND
  Twenty to fifty percent of patients with psoriasis have depressive symptoms.
  
  
  OBJECTIVE
  To describe the effects of biologics (tumour necrosis factor inhibitors [TNFi] or interleukin 12/23 inhibitors [IL-12/23i]) on depressive symptoms in patients with psoriasis.
  
  
  METHODS
  Electronic databases were searched for randomized controlled trials (RCTs) examining the effects of biologics on depressive symptoms in adults with psoriasis.
  
  
  RESULTS
  Of the 305 publications identified, three RCTs were included in a systematic review. In a trial evaluating ustekinumab, mean change in Hospital and Anxiety Depression Rating Scale at 24 weeks from baseline was 3.1 with ustekinumab (P < 0.001) vs. 0.21 with placebo (not significant). In a trial evaluating adalimumab, mean change in Zung Self-Rating Depression Scale at 12 weeks from baseline was -6.7 with adalimumab vs. -1.5 with placebo. In a trial evaluating etanercept, the between-group difference at 12 weeks in Beck Depression Inventory Scale was 1.8 (95% CI: 0.6, 2.90) in favour of etanercept over placebo. Limitations are that diagnostic criteria for depression were not used and scales and data from individual RCTs could not be combined.
  
  
  CONCLUSIONS
  Adalimumab, etanercept and ustekinumab were associated with statistically significant reductions in depressive symptom scores using various scales in patients with moderate-to-severe psoriasis.
authors.affiliation: Division of Dermatology, University of Toronto, Toronto, ON, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Fleming
authors.affiliation: Notre-Dame Hospital, University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Roubille
authors.affiliation: Department of Medicine, Dermatology Service, St-Luc Hospital, Montreal, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Richer
authors.affiliation: Sacré-Coeur Hospital of Montreal, University of Montreal, Montreal, QC, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Starnino
authors.affiliation: Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.
authors.forename: C
authors.initials: C
authors.lastname: McCourt
authors.affiliation: Division of Rheumatology, University of Alberta, Edmonton, AB, Canada.
authors.forename: A
authors.initials: A
authors.lastname: McFarlane
authors.affiliation: Division of Rheumatology, Department of Medicine, Western University, St. Joseph's Health Care, London, ON, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Siu
authors.affiliation: Lynde Dermatology, Markham, ON, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Kraft
authors.affiliation: Lynde Dermatology, Markham, ON, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Lynde
authors.affiliation: Division of Rheumatology, Department of Medicine, Western University, St. Joseph's Health Care, London, ON, Canada.
authors.forename: J E
authors.initials: JE
authors.lastname: Pope
authors.affiliation: Division of Rheumatology, University of Alberta, Edmonton, AB, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Keeling
authors.affiliation: Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Dutz
authors.affiliation: Department of Medicine, Rheumatic Disease Unit, Centre Hospitalier Universitaire de Québec (pavillon CHUL), Quebec City, QC, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Bessette
authors.affiliation: Innovaderm Research, Montreal, QC, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Bissonnette
authors.affiliation: Department of Medicine, Rheumatic Disease Unit, Centre Hospitalier de l'Université de Montréal (CHUM) and Institut de Rhumatologie de Montréal, Montreal, QC, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Haraoui
authors.affiliation: Department of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
authors.forename: W P
authors.initials: WP
authors.lastname: Gulliver
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003863:Depression / Q000188:drug therapy / Q000209:etiology*; D003879:Dermatologic Agents / Q000627:therapeutic use; D000068800:Etanercept / Q000627:therapeutic use*; D006801:Humans; D011565:Psoriasis / Q000188:drug therapy* / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D016032:Randomized Controlled Trials as Topic; D000069549:Ustekinumab / Q000627:therapeutic use*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D003879:Dermatologic Agents; D000069549:Ustekinumab; D000068879:Adalimumab; D000068800:Etanercept