Systemic Treatment of Atopic Dermatitis Relieves Skin Symptoms and Reduces Depression

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.

Resources:

1. International Society of Atopic Dermatitis (ISAD) 2022: Abstract OL.18, Presented October 18, 2022.