Psychiatric Adverse Effects of Biologic and Novel Systemic Agents for Psoriasis and Inflammatory Bowel Disease: A Case Series and Literature Review.

Abstract

Background: Psychiatric symptoms have been reported with certain biologic and novel systemic therapies for psoriasis and inflammatory bowel disease (IBD), but the extent and nature of these effects remain unclear. We summarize the literature and present two illustrative cases to highlight potential associations.

Methods: We describe two patients who developed psychiatric symptoms shortly after starting systemic or biologic agents for psoriasis. We then conducted a targeted literature review of PubMed, Embase, and PsycINFO to identify reports of psychiatric adverse effects associated with biological and novel systemic therapies.

Results: A review of these databases found 482 results for these agents and psychiatric adverse effects. After excluding duplicate articles and articles that did not mention psychiatric adverse effects, we found 34 articles that described psychiatric adverse effects. There was overall improvement in depressive and anxiety symptoms with the use of biological agents as a class, however, there are case reports of psychiatric adverse effects of these medications. Infliximab, brodalumab, and apremilast have the most evidence regarding psychiatric adverse effects, with brodalumab having a boxed warning for suicidality and apremilast's manufacturer recommending careful monitoring for psychiatric symptoms.

Conclusions: Despite improvement in depressive or anxiety symptoms with these agents, psychiatric symptoms may emerge during treatment underscoring the need for careful monitoring. Clinicians should consider individual psychiatric history when selecting immune-modulating therapies for psoriasis and IBD.