Complete Skin Clearance is Associated with HADS-Defined Absence of Anxiety and Depressive Symptoms After IL-17A Inhibitor Treatment in Moderate-to-Severe Psoriasis: Evidence from the SPEECH Cohort.

BACKGROUND: Psoriasis is a chronic immune-mediated disease associated with anxiety, depressive symptoms, and impaired quality of life, potentially involving interacting psychosocial and inflammatory pathways. During biologic treatment, psychological symptoms may improve alongside skin disease, but whether complete skin clearance (CSC) is associated with Hospital Anxiety and Depression Scale (HADS)-defined absence of anxiety and depressive symptoms remains unclear. OBJECTIVE: To examine whether CSC, defined as PASI100, was associated with HADS-defined absence of anxiety and depressive symptoms after 12-week IL-17A inhibitor treatment in moderate-to-severe psoriasis. METHODS: Patients receiving IL-17A inhibitors were identified from the Shanghai Psoriasis Effectiveness Evaluation CoHort (SPEECH). Eligible patients had complete baseline data, week-12 Psoriasis area and severity index (PASI) and HADS assessments. PASI responses represented percentage improvement from baseline and were categorized as PASI<75, PASI75-<100, or PASI100. The primary outcomes were week-12 HADS-A = 0 and HADS-D = 0, and the secondary outcomes were week-12 HADS-A and HADS-D as continuous outcomes. Logistic and linear regression, subgroup, and sensitivity analyses were performed. RESULTS: Among 233 patients, 32 (13.7%) achieved PASI<75, 99 (42.5%) PASI75-<100, and 102 (43.8%) PASI100. Baseline HADS-A and HADS-D were comparable across groups. Compared with PASI100, PASI75-<100 was associated with lower odds of HADS-A = 0 (adjusted OR [aOR], 0.40; 95% confidence interval [CI], 0.20-0.78) and HADS-D = 0 (aOR, 0.48; 95% CI, 0.25-0.95), and higher week-12 HADS-A (adjusted β, 1.10; 95% CI, 0.34-1.86) and HADS-D (adjusted β, 0.95; 95% CI, 0.18-1.72). For PASI<75 versus PASI100, the corresponding aORs for HADS-A = 0 and HADS-D = 0 were 0.22 (95% CI, 0.08-0.62) and 0.27 (95% CI, 0.09-0.81), respectively. Subgroup and sensitivity analyses yielded consistent findings. CONCLUSION: CSC was associated with a higher likelihood of HADS-defined absence of anxiety and depressive symptoms in the treatment of moderate-to-severe psoriasis.