’Crystel’ clear: Study shows etanercept improves depression, anxiety in psoriasis patients

International report - Etanercept therapy helps to improve symptoms of depression and anxiety long-term in patients suffering from moderate-to severe psoriasis, according to the results of the Crystel study.

"Psoriasis not only affects the skin of the patient, but can also have a rather serious psychological impact on the psyche of the patient, often leading to sometimes severe depression and anxiety.

"This can significantly negatively impact the quality of life of this patient population," says study co-author Julien Lambert, M.D., Ph.D., department of dermatology, University Hospital, Antwerp, Belgium.

Co-researchers are C.E.M. Griffiths M.D., Dermatology Centre, University of Manchester, Manchester, England; Esteban Dauden, M.D., department of dermatology, Hospital Universitario de la Princesa, Madrid, Spain; and Joanne Estojak, M.S., Debbie Robertson M.S., Charles Molta, M.D. and Robert Boggs, Ph.D., of Wyeth Research, Collegeville, Pa.

Crystel study

The Crystel study evaluated the effect of etanercept therapy on symptoms of depression and anxiety in patients with active moderate-to-severe psoriasis.

The prevalence of depression and anxiety symptoms in the study patients improved as early as 12 weeks into therapy with etanercept, and could be sustained up to week 54, regardless of whether patients received continuous or intermittent etanercept treatment.

These significant improvements in the psychological status of patients could be correlated to improvements seen in their PASI scores.

Study parameters

In the 54-week, open-label study, 711 patients were randomized to etanercept treatment, either continuous or intermittently.

Patients in the continuous therapy arm received 25 mg of etanercept twice weekly, whereas those in the intermittent therapy arm received 50 mg of etanercept twice weekly in a treat-to-target fashion, with temporary cessation of therapy based on the achievement of a PGA (Physician Global Assessment) score of "mild" or better.Depression and anxiety were assessed at baseline and at weeks 12, 24, 36 and 54, or at time of discontinuation, using the Hospital Anxiety and Depression Scale depression (HADS-D) and anxiety (HADS-A) subscales, a screening tool specific for symptoms of anxiety and depression.

Mean PASI (Psoriasis Area and Severity Index) scores were compared before and after treatment course.

At baseline, 30.2 percent of patients in the continuous therapy group and 36.7 percent of the patients in the intermittent therapy group had at least mild symptoms of depression.

Results

Results showed that at the end of the 54-week trial with etanercept, these symptoms of depression were present in only 17.5 percent and 23.1 percent of patients, respectively.

The mean improvements in HADS-D scores for the two groups from baseline were 30.4 percent and 25.1 percent, respectively.

Dr. Lambert and co-authors noted that similar positive results were seen in the improvement of anxiety symptoms.

Here, 40.2 percent of the continuous therapy group and 48.5 percent of the intermittent therapy group had at least mild symptoms of anxiety at baseline.

However, at week 54, these symptoms of anxiety had significantly decreased and were present in only 25.1 percent and 31.8 percent of patients, respectively.

The mean improvements in HADS-A scores from baseline were 27.3 percent and 24.4 percent, respectively.

Results also showed that the mean PASI score improved dramatically, from a baseline of 21.89 for the continuous therapy group and 22.75 for the intermittent therapy group to 7.11 and 9.45, respectively, at week 54.

Quality of life

The prevalence of depression in psoriasis patients has been reported to range from 10 percent to 58 percent. Furthermore, approximately 43 percent of psoriasis patients suffer from anxiety, confounding an already challenging and psychologically burdensome physical and psychological condition.

"We know from our daily practice that psoriasis patients treated with TNF-alpha inhibitors gain substantially in quality of life.

"The results of this study confirm that many patients have symptoms of depression and anxiety and that treatment with etanercept can improve this problem and, meanwhile, their quality of life," Dr. Lambert says. DT

Disclosures: This study was funded by Wyeth Research, Collegeville, Pa.