Psoriasis biologics were linked to less depression and anxiety in the short term

Design

Systematic review and frequentist network meta-analysis of randomised trials and prospective comparative cohorts

Population

4,319 adults with moderate-to-severe plaque psoriasis in 8 studies

Primary outcome

Change in depression and anxiety symptom scores versus placebo

Effect

Depression SMD 0.677 (95% CI 0.473 to 0.881) for IL-12/23; anxiety SMD 0.457 (0.304 to 0.610) for IL-23

This network meta-analysis combined eight randomised or prospective comparative studies (4,319 adults) of biologic therapy in moderate-to-severe plaque psoriasis and looked at depression and anxiety scores.

At the mechanism level, every biologic class improved both against placebo. For depression the largest estimate was for IL-12/23 inhibitors (SMD 0.677, 95% CI 0.473 to 0.881). For anxiety, IL-23 inhibitors (SMD 0.457, 95% CI 0.304 to 0.610) and IL-12/23 inhibitors (SMD 0.457, 95% CI 0.335 to 0.579) were similar. At drug level, rankings were uncertain, with sparse networks and certainty from high to low. Mood improvement generally followed skin improvement but was not strictly proportional.

For clinic, the finding supports asking about mood in psoriasis and counting it as part of treatment benefit. It does not support choosing a biologic for its antidepressant effect.

• Screen for depression and anxiety in moderate-to-severe psoriasis at baseline and at review.
• Treat mood symptoms in their own right; skin clearance may not resolve them.
• Do not pick a biologic on the strength of these rankings, which were uncertain.
• Refer for psychological support when symptoms persist despite good skin response.

Why it matters

It reframes psoriasis treatment success as more than skin clearance.

Don't overread it

Short-term data from few studies; it cannot say that one biologic is better for mood or that mood benefit persists.

The statistics, in plain English

An SMD of about 0.5 to 0.7 is a moderate effect on symptom scales. Network meta-analyses infer indirect comparisons between drugs that were never tested head to head, and with only eight studies the ranking of individual drugs is fragile.

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