Clinical Edge

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Biological Treatment and Fatigue in Psoriasis

Biological agents used for the treatment of psoriasis vulgaris have a consistently small-to-moderate beneficial effect on patient fatigue independent of the type of drug, according to a recent review. Researchers conducted a meta-analysis of randomized controlled trials (RCTs) in which anti-interleukin-12/23, anti-interleukin-23, anti-interleukin-17, or anti-tumor necrosis factor-α agents were used for psoriasis vulgaris with fatigue as an outcome measure. They found:

  • 8 RCTs met inclusion criteria.
  • The studies used 2 fatigue reporting scales: the Functional Assessment of Chronic Illness Therapy-Fatigue and the Short Form 36 Health Survey Vitality Subscale.
  • Compared with placebo, treatment by biological agents in general led to a significant reduction in fatigue (mean difference of -0.40).

Citation:

Skoie IM, Dalen I, Omdal R. Effect of biological treatment on fatigue is psoriasis: A systematic review and meta-analysis. [Published online ahead of print April 2, 2019]. Am J Clin Dermatol. doi:10.1007/s40257-019-00434-w.

Commentary:

Fatigue is a symptom that has largely gone unrecognized when inquiring about signs and symptoms in psoriatic patients. Fatigue is more commonly associated with people with psoriatic arthritis and elevated levels of inflammatory markers such as C-reactive protein. Unlike psoriatic arthritis, psoriasis itself is not associated with elevated inflammatory markers. Nonetheless, fatigue can be a sign of subclinical signs of psoriatic arthritis. Often times, systemic or biologic therapy can make a person feel less tired at the beginning of therapy. Further studies will be needed to address fatigue and its true correlation in psoriasis with regards to psoriatic arthritis. —Paul S. Yamauchi, MD, PhD; Clinical Assistant Professor of Dermatology David Geffen School of Medicine at UCLA; Harbor-UCLA Medical Center Division of Dermatology; Adjunct Associate Professor John Wayne Cancer Institute.