Abstract
Abstract
Background
Various biologics are already widely used to treat patients with moderate-to-severe psoriasis, but there is currently a lack of comparative data on their effectiveness in improving symptoms of anxiety and depression.
Objective
To evaluate and compare the effects of biologic therapies on depression and anxiety symptoms in patients with psoriasis using a systematic review and network meta-analysis.
Methods
We searched PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials from inception to January 28, 2026. Randomized controlled trials and prospective comparative cohort studies in adults with moderate-to-severe psoriasis were included. Frequentist random-effects NMA was conducted at mechanism and drug levels, with network incoherence, sensitivity analyses, risk of bias, and certainty of evidence assessed. Skin-response associations and clinically interpretable psychological outcomes were additionally summarized.
Results
Eight studies involving 4,319 patients were included. At the mechanism level, all biologic classes significantly improved depression and anxiety symptoms versus placebo. For depression, IL-12/23 inhibitors had the largest estimate [standardized mean difference (SMD) = 0.677, 95% confidence interval (CI): 0.473, 0.881]; for anxiety, IL-23 (SMD=0.457, 95%CI: 0.304, 0.610) and IL-12/23 (SMD=0.457, 95%CI: 0.335, 0.579) inhibitors had similar estimates. At the drug level, several agents showed benefit, but rankings were uncertain because networks were sparse and certainty ranged from high to low. Within-study and exploratory comparison-level analyses indicated that psychological improvement generally accompanied skin improvement, yet the two were not strictly proportional.
Conclusion
Biologic therapy was associated with short-term improvement in depressive and anxiety symptoms in moderate-to-severe psoriasis, supporting mental health as a relevant component of overall treatment benefit. Psychological improvement generally accompanied skin response, while comparative differences across mechanisms and individual agents require confirmation in larger and longer randomized studies.