Relationship Between the Response to Antibody Therapy and Symptoms of Depression and Anxiety Disorders in Patients with Severe Asthma

Abstract

Purpose Asthma is associated with a high prevalence of psychopathological disorders, especially depressive disorders or anxiety. In patients with uncontrolled severe asthma, monoclonal antibody (mAb)-therapy positively influenced control of mental disorders. Therefore, we evaluated the impact of antibody therapy on the burden of these mental diseases depending on responder status. Patients and Methods Data were collected retrospectively in patients with uncontrolled severe asthma (n = 82) prior to mAb-therapy (“baseline”) (omalizumab, dupilumab, benralizumab or mepolizumab). Symptoms of Major Depressive Disorder (MDD) or General Anxiety Disorder (GAD) were detected at baseline using the Hospital Anxiety and Depression Scale (HADS), as well as general sociodemographic data and lung function parameters. At 6-month (±3 month) follow-up, the burden of psychopathological symptoms under mAb-therapy was assessed using the Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder Scale-2 (GAD-2). Response status was classified using the Biologics Asthma Response Score (BARS), assessing exacerbations, oral corticosteroid usage and asthma control test (ACT) score. Predictors for non-response to mAb-therapy were identified using linear regression analysis. Results Patients with severe asthma suffered from symptoms of MDD/GAD more often compared to the general population, with a higher prevalence among mAb therapy non-responders. mAb-responders exhibited a declining burden of MDD, better quality of life (QoL), less exacerbations, better lung function and better disease control compared to non-responders. A history of symptoms of depression was identified as a predictor for non-response to mAb-therapy. Conclusion Asthma symptoms and psychological problems are linked and more prevalent in our cohort of severe asthma patients than in the general population. Patients with signs of MDD/GAD before mAb-therapy show less mAb therapy response suggesting a negative impact of prior psychological problems on treatment response. In some patients, the score on MDD/GAD was caused by severe asthma – here symptoms decreased after effective treatment.

Which Factors Are Associated with Persistence of Depressive and Anxiety Symptoms in Patients Affected by Atopic Dermatitis despite 2-Year Treatment with Dupilumab?

“…As previously mentioned, the remission of depressive and anxiety symptoms in patients with AD is crucial, as the response to antibody treatment may be reduced in the presence of these types of symptoms, as shown in samples of patients affected by asthma [39]. Of note, a minority but significant part of patients with AD manifest affective disorders after long-term treatment with dupilumab.…”

“…This study has several limitations which should be noted: First of all, there was no randomization in the assignment of therapy with dupilumab, and there was no control group. Moreover, medical and psychiatric comorbidities [39] may have influenced the mental health of the sample, while previous pharmacological treatment may have contributed to the onset of affective disorders (e.g., systemic corticosteroids and mood symptoms). Finally, the context of the pandemic may have impacted on the mental health of fragile subjects, such as patients with AD [54,55].…”

Long-term multicenter comparison shows equivalent efficacy of monoclonal antibodies in severe asthma therapy

“…A key causative factor in this inflammatory process are elevated levels of pro-inflammatory interleukins (IL)-4, -5 and -13 [ 5 , 6 ]. Exacerbations are frequent and often severe in these patients, causing a high burden of direct and indirect morbidity and health-care associated costs [ 7 – 9 ]. Beyond recurrent exacerbations, the underlying type-2 inflammation may lead to airway remodeling and permanent loss of lung function [ 10 ].…”

Long-term multicenter comparison shows equivalent efficacy of monoclonal antibodies in severe asthma therapy

“…[5,6] Exacerbations are frequent and often severe in these patients, causing a high burden of direct and indirect morbidity and health-care associated costs. [7][8][9] Beyond recurrent exacerbations, the underlying type-2 in ammation may lead to airway remodeling and permanent loss of lung function. [10] Treatment of type-2 asthma has been revolutionized by the development of monoclonal antibodies (hereafter called biologics) targeting the underlying in ammatory pathways.…”