Psoriasis (Auckland, N.Z.) · 2026
Four Weeks of Biologic Treatment are Sufficient to Normalize Blunted HPA-Axis Activity and Significantly Improve Psychological Burden in Patients with Psoriasis.
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Krefting Frederik, Hölsken Stefanie, Savvidou Paraskevi, Sollfrank Lukas, Thielmann Carl Maximilian, Placke Jan-Malte, Moelleken Maurice, Ocker-Serger Lennart, Albrecht Lea Jessica, Dissemond Joachim, Benson Sven, Schedlowski Manfred, Sondermann Wiebke
Аннотация
PURPOSE: Psoriasis is associated with substantial psychological burden and dysregulation of endocrine pathways, including the hypothalamic-pituitary-adrenal (HPA) axis. Although biologic therapies improve skin disease, early changes in psychological burden and HPA-axis activity remain insufficiently characterized. This study addresses this scientific gap.
PATIENTS AND METHODS: This prospective observational study analyzed data from n = 50 patients with moderate-to-severe psoriasis who were assessed at baseline and after 4 weeks of biologic therapy, and from n = 50 matched healthy controls evaluated at baseline. Primary psychological outcomes were depressive symptoms, anxiety, and perceived stress, measured using Beck's Depression Inventory (BDI), the State-Trait Anxiety-Depression Inventory (STADI), and the Perceived Stress Scale (PSS). Plasma cortisol levels were analyzed in a sampling-time-matched subgroup of n = 25 patients and n = 25 healthy controls.
RESULTS: At baseline, patients with psoriasis showed pronounced psychological distress compared with healthy controls, including higher depressive symptoms, state and trait anxiety, state and trait depression, and perceived stress. After 4 weeks of biologic treatment, patients with psoriasis showed significant improvements in BDI, STADI state anxiety, STADI trait anxiety, and PSS scores (all p ≤0.002). By week 4, BDI scores, trait anxiety, and perceived stress were no longer different between patients and controls according to Bonferroni-adjusted tests. Baseline plasma cortisol in patients with psoriasis was lower than in controls (p =0.015) and increased significantly after 4 weeks (p =0.008), no longer differing from healthy controls (p =0.839). Concurrently, PASI decreased from 16.9 to 7.2 after 4 weeks of biologic therapy (p <0.001).
CONCLUSION: After only 4 weeks of biologic therapy, patients with psoriasis showed marked improvement in psychological burden, and plasma cortisol shifted from a reduced baseline level toward the range observed in healthy controls, consistent with early normalization of HPA-axis activity.
PATIENTS AND METHODS: This prospective observational study analyzed data from n = 50 patients with moderate-to-severe psoriasis who were assessed at baseline and after 4 weeks of biologic therapy, and from n = 50 matched healthy controls evaluated at baseline. Primary psychological outcomes were depressive symptoms, anxiety, and perceived stress, measured using Beck's Depression Inventory (BDI), the State-Trait Anxiety-Depression Inventory (STADI), and the Perceived Stress Scale (PSS). Plasma cortisol levels were analyzed in a sampling-time-matched subgroup of n = 25 patients and n = 25 healthy controls.
RESULTS: At baseline, patients with psoriasis showed pronounced psychological distress compared with healthy controls, including higher depressive symptoms, state and trait anxiety, state and trait depression, and perceived stress. After 4 weeks of biologic treatment, patients with psoriasis showed significant improvements in BDI, STADI state anxiety, STADI trait anxiety, and PSS scores (all p ≤0.002). By week 4, BDI scores, trait anxiety, and perceived stress were no longer different between patients and controls according to Bonferroni-adjusted tests. Baseline plasma cortisol in patients with psoriasis was lower than in controls (p =0.015) and increased significantly after 4 weeks (p =0.008), no longer differing from healthy controls (p =0.839). Concurrently, PASI decreased from 16.9 to 7.2 after 4 weeks of biologic therapy (p <0.001).
CONCLUSION: After only 4 weeks of biologic therapy, patients with psoriasis showed marked improvement in psychological burden, and plasma cortisol shifted from a reduced baseline level toward the range observed in healthy controls, consistent with early normalization of HPA-axis activity.