BIOLOGIC THERAPIES FOR PSORIASIS DECREASE THE RISK TO DEVELOP MAJOR DEPRESSIVE DISORDER

D. Arnheim, A. Dotan, N. Ben-Shabat, D. Amitale, D. Mcgonagle, A. Watad, M. Weiser, H. AmitalZabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel, Department of Medicine ‘B’, Ramat-Gan, Israel Beer-Yaakov/Ness-Ziona Mental Health Center, Beer-Yaakov/Ness-Ziona Mental Health Center, Beer-Yaakov, Israel University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom Sheba Medical Center, Tel Hashomer., Division of Psychiatry, Ramat-Gan, Israel  Background Major depression is some of the numerous comorbidities associated with psoriasis (PsO) and psoriasis arthritis (PsA) [1]. Objectives Assessing the risk of developing depression in patients with pre-existing PsO treated with different treatment regimens; topical treatment, conventional disease-modifying anti-rheumatic drugs (cDMARDs), and biologic disease-modifying anti-rheumatic drugs (bDMARDs), which had not previously studies sufficiently on real-world data. Methods We conducted a retrospective exploratory study with real-world data using the databases of the third largest Israeli health maintenance organization, ‘Meuhedet’ which covers approximately 1,300,000 subjects. All patients of ‘Muehedat’ diagnosed with PsO from January 2000 until January 2020 were included in the analysis. Overall, 61,003 patients with PsO were detected. In addition, each PsO patient was paired with four control subjects by gender, age, and ethnicity (general, Arabic, or Orthodox). We defined PsO and PsA according to physicians’ diagnoses. Depression included patients with either Selective serotonin reuptake inhibitors (SSRI) treatment or the physicians’ diagnoses of depression. The date of the depression incident was defined by the first occurrence of the first to occur. We classified the patients diagnosed with PsA into a separate group; thus, patients were categorized according to their diagnosis (control, PsO or PsA). Furthermore, we analyzed the patients by the most advanced treatment prescribed to the patient; sub-grouped 1- topical therapy, phototherapy, or no therapy, sub-grouped 2 - cDMARDs (methotrexate or sulfasalazine), sub-grouped 3 - bDMARDs (anti-TNF, anti-IL17, or anti-IL12/23 agents) (Table 1). The Incident cases of depression were analyzed according to the different lines of therapy mentioned above. In addition, Time-dependent Cox proportional hazard models were used to evaluate the adjusted risk of developing MACE by treatment group. Results 231,584 patients were included after exclusion by the defined criteria, contributing a total of 2,917,319 patient-years. Adjusted Cox proportional hazards regression analysis showed that the risk of developing depression in PsO patients treated with topical treatment and those treated with bDMARDs was significantly higher in comparison to controls (Topical, HR: 1.06, CI: 1.04 - 1.09, p-value: <0.001; bDMARDs, HR: 2.08, CI: 1.76 - 2.45, p-value: <0.001). Yet, the risk of developing depression in PsO patients treated with cDMARDs was significantly lower compared to controls (HR: 0.66, CI: 0.5 – 0.87, P-value: 0.003). Similarly, the risk of developing depression in PsA patients treated with topical treatment and those treated with bDMARDs was significantly higher in comparison to controls (Topical, HR: 1.67, CI: 1.56 - 1.78, p-value: <0.001; bDMARDs, HR: 1.86, CI: 1.66 – 2.1, p-value: <0.001). Yet, the risk of depression in PsA patients treated with cDMARDs was not significantly different compared to controls (HR: 0.91, CI: 0.77 – 1.08, p-value: 0.29). (Figure 1). This analysis was adjusted to gender, body mass index (BMI), and age of PsO diagnosis; notably, female gender, higher BMI, and older age were all associated with a greater risk of developing depression. Conclusion Despite the fact that psoriasis and arthritis severity is higher in patients treated with cDMARDs compared to those treated with topical therapy, cDMARDs have a protective effect on the risk of developing depression. On the contrary, biological treatment increases the risk of depression, possibly due to the high severity of the disease, yet also have a protective effect compared to those treated with topical therapy. Reference [1]Murray CJ, Abraham J, Ali MK, Alvarado M, Atkinson C, Baddour LM, Bartels DH, Benjamin EJ, Bhalla K, Birbeck G, Bolliger I. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. Jama. 2013 Aug 14;310(6):591-606. Acknowledgements: NIL. Disclosure of Interests None Declared. Keywords: bDMARD DOI: 10.1136/annrheumdis-2023-eular.6485Citation: , volume 82, supplement 1, year 2023, page 1768Session: Psoriatic arthritis - treatment (Publication only)