The Role of Tumour Necrosis Factor Alpha Inhibitors in Psychiatric Comorbidities in Psoriasis: Literature Review

摘要

Introduction: Tumor necrosis factor alpha (TNF-alpha) play a central role in psoriasis pathophysiolgy. TNF-alpha inhibitors are widely and efficient used for the treatment of this disease. Depression is an important comorbidity in psoriasis. Recent studies have suggested that TNF-alpha is implicated in pathophysiology of depression. It is hypothesized that blockade of TNF-alpha may offer substantial benefits in treating depression. Psoriasis is an excellent model of disease which may provide consistent data about the potential of TNF-alpha antagonists to become a new treatment option for depression, at least for the type associated with inflammation. Objective: The aim of this paper is to investigate the hypothesis that TNF- alpha inhibitors are a potential new class of drugs for major depressive disorder using psoriasis model. Methods: It was conducted a narrative review of randomized clinical trials which investigate the effect of TNF-alpha on psychiatric comorbidities in psoriasis patients. Results: Seven randomized clinical trials informed this paper. Depression and associated somatic symptoms were assessed in these studies.There were used a variety of psychometric instruments. Low intensity depression was found at baseline. Impairment in sleep and great levels of fatigability were found in psoriasis patients versus general population. Improvement in depression was statistically significant in treated patients versus placebo groups. Sleep and fatigability were improved after treatment with TNF- alpha inhibitors. Correlations between improvement in depression and improvement in psoriasis lesions and other associated symptoms (e.g. psoriasis arthritis, skin pain, pruritus) in studies reviewed were not consistent. Conclusion: This review showed that TNF-alpha inhibitors offer therapeutic benefit in affective and somatic symptoms of depression associated with psoriasis. Reviewed data didn't offer informational support to conclude that TNF-alpha inhibitors have direct and independent effects on depression in psoriasis or the effects are related to improvements in psoriatic lesions and other psoriasis characteristics. There are needed further studies which include psoriasis patients with higher level of depression to investigate the effect of TNF-alpha on this frequent comorbiditiy.