Depression In Psoriasis Research Articles

Itch Is More Important than Clinical Disease Severity for Depression in Psoriasis: A Prospective Register Study

Itch Is More Important than Clinical Disease Severity for Depression in Psoriasis: A Prospective Register Study

Elevated C-Reactive Protein and Erythrocyte Sedimentation Rate Correlates with Depression in Psoriasis: A Chinese Cross-Sectional Study.

Psoriasis patients often suffers from anxiety and depression. Inflammation, anxiety, and depression have been associated with each other, but the relationship has not been examined in subjects with psoriasis. The primary objective was to investigate the relationship between the C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) and depression among patients with psoriasis. In this case-control, cross-sectional study, 239 individuals with psoriasis and 142 with healthy controls (HCs) were recruited. Psychological as well as clinical, and laboratory data were collected. 50.2% of subjects with psoriasis reported depressive symptoms, compared with 26.8% of HCs. 39.7% and 17.6% observed anxiety symptoms in psoriasis patients and HCs. The odds of anxiety (AOR= 3.123; 95% CI = 1.851-5.269) and depression (AOR= 2.698; 95% CI = 1.690-4.306) were higher in psoriasis patients relative to HCs. Furthermore, the elevated CRP (AOR =2.139; 95% CI = 1.249-3.663) and ESR (AOR =1.827; 95% CI = 1.078-3.096) were the risk factors of depression in patients with psoriasis. The threshold for distinguish psoriasis patients in depression was 3.24 (area under the curve [AUC], 0.605; sensitivity, 0.57; specificity, 0.64) for CRP and 26.5 (AUC, 0.632; sensitivity, 0.52; specificity, 0.73) for ESR. A substantial prevalence of anxiety and depression symptoms was observed in Chinese psoriasis subjects, and the odds were much higher in psoriasis patients relative to HCs. The elevated CRP and ESR level was significantly associated with depression in psoriasis patients. Besides, the discrimination capability of CPR and ESR on depression further indicates the extra value of inflammatory biomarkers in the management of psoriasis patients.

The potency of common proinflammatory cytokines measurement for revealing the risk and severity of anxiety and depression in psoriasis patients.

ObjectiveProinflammatory cytokines mediate anxiety and depression in various ways, such as immunity, inflammation, and the hypothalamic–pituitary–adrenal axis. This study intended to further explore the linkage of common proinflammatory cytokine levels with anxiety and depression in psoriasis patients.MethodsTotally, 150 psoriasis patients and 50 healthy controls (HCs) were included; the serum samples were collected, then common proinflammatory cytokines were measured by ELISA. Hospital Anxiety and Depression Scale (HADS) was assessed.ResultsHADS‐anxiety (HADS‐A) score, HADS‐depression (HADS‐D) score, TNF‐α, IL‐1β, IL‐6, IL‐12, IL‐17A, and IL‐23 were all increased in psoriasis patients compared to HCs (all p < 0.05). In psoriasis patients, TNF‐α (p = 0.001), IL‐12 (p = 0.035), and IL‐17A (p < 0.001), but not IL‐1β (p = 0.255), IL‐6 (p = 0.248), and IL‐23 (p = 0.216), were positively linked to HADS‐A score. Meanwhile, TNF‐α (p = 0.007) and IL‐17A (p = 0.007) were enhanced in psoriasis patients with anxiety in contrast to those without anxiety; whereas IL‐1β (p = 0.178), IL‐6 (p = 0.360), IL‐12 (p = 0.239), and IL‐23 (p = 0.450) were not different. TNF‐α (p < 0.001), IL‐1β (p = 0.013), Il‐17A (p < 0.001), and IL‐23 (p = 0.023), but not IL‐6 (p = 0.143) and IL‐12 (p = 0.158), were positively linked to HADS‐D score. Concurrently, TNF‐α (p = 0.015), IL‐17A (p < 0.001), and IL‐23 (p = 0.017) were climbed in psoriasis patients with depression by comparison to those without depression; whereas IL‐1β (p = 0.113), IL‐6 (p = 0.237), IL‐12 (p = 0.660) did not differ.ConclusionTNF‐α, IL‐17A, and IL‐23 increments reflect anabatic anxiety and depression in psoriasis patients, uncovering the potency of proinflammatory cytokines measurement for monitoring or even preventing psoriasis patients' anxiety and depression.

Happiness and depression in psoriasis: a cross-sectional study in Germany

PurposePrior research on the psychological consequences of skin diseases has focused on assessing mental comorbidities. The aim of this study was to investigate subjective well-being in a large sample of individuals affected by psoriasis, a chronic inflammatory skin disease, and to explore the associations with depression and disease-related parameters such as disease severity.MethodsA cross-sectional online survey was conducted from March to June 2019. The link to the questionnaire was shared on websites and Facebook pages of psoriasis patient organizations and campaigns. Participants filled in validated scales measuring subjective well-being—operationalized as positive affect (PA), negative affect (NA) and satisfaction with life (SWL); and depression.ResultsThe data of 722 participants were analyzed. Exploratory factor analysis supported the differentiation of PA, NA, SWL, and depression as four different constructs. The respondents reported lower levels of PA than healthy individuals and judged themselves to be less happy and were less satisfied with their lives than the general population (except age group 65 + years). 40.3% of respondents were screened positive for depression. More severe psoriasis was associated with lower affective well-being and a higher risk for depression.ConclusionThe results of this study empirically supported the differentiation of subjective well-being and depression as different constructs in individuals with psoriasis, and underline the large mental burden of the disease which goes beyond a higher risk for depression. Measures of well-being should thus be incorporated in both research and clinical practice in patients with psoriasis in order to achieve a more comprehensive picture of the mental burden of this disease.

Effectiveness of psychopharmacotherapy in psoriasis patients with associated anxiety and depression.

Psoriasis is associated with psychological comorbidities. We evaluated the effectiveness of additional psychopharmacotherapy on the clinical severity and associated anxiety and depression in psoriasis. 173 patients were enrolled with psoriasis and associated anxiety and depression. Spielberger State-Trait Anxiety Inventory (STAI) and The Beck Depression Scale (BDI) were used to assess anxiety and depression parameters. The IA main group included patients with anxiety disorders who received Mebicar. The IB main group consisted of patients with anxiety and depressive disorders who received Mianserin. The II group comprised patients with anxiety disorders (IIA comparison group) and patients with anxiety and depressive disorders (IIB comparison group), who received only traditional therapy. The level of anxiety in patients of the IA and IB main groups decreased by 2.1 times. The level of depression in the IB main group significantly decreased by 1.7 times, while in the IIB comparison group, this indicator remained almost at the same level. Patients of the IA and IB main groups had PASI50 on average on 15 to 16 days of treatment. PASI50 was achieved in the both comparison groups only at 21 to 22 days. PASI75 occurred in the IA and IIB main groups almost simultaneously on 28 to 29 days of treatment. But in the IIA and IIB comparison groups, these positive changes occurred significantly later than in patients of the main groups (on 34-35 days of treatment). Additional psychopharmacotherapy significantly reduced anxiety and depression in both groups IA and IB, as compared to patients in groups IIA and IIB who received only traditional therapy.

Examining Individual Differences in Wellbeing, Anxiety and Depression in Psoriasis Using a Clinically Modified Buddhist Psychological Model.

Psoriasis patients can experience a range of psychosocial difficulties, which can lead to issues with wellbeing, anxiety and depression. Mindfulness-based interventions have positive impacts on these outcomes; however, there is a need to identify the mechanisms of action of such interventions. This study attempts to do so by examining individual differences in psoriasis patients' wellbeing, anxiety and depression using a clinically modified Buddhist psychological model (CBPM). Psoriasis patients (N = 285) and (N = 209) completed measures of each CBPM component at time 1 and 2. SEM analyses found that a direct and mediated effect of CBPM model was a good fit to the participant's data. This study suggests that non-attachment, aversion, acceptance and self-compassion could have a direct effect on the wellbeing, anxiety and depression of psoriasis patients and an indirect effect through reduced worry and rumination. This study provided preliminary evidence for the CBPM as being a useful explanatory framework of psoriasis patients' anxiety, depression and wellbeing.

Review of suicide and depression in psoriasis and management of suicide warnings in patients treated with psoriasis drugs

Patients with psoriasis are thought to be at increased risk of depression, anxiety and suicidality predominantly as a result of the psychosocial impact of this disease. Studies have shown that the pro-inflammatory cytokines that are elevated in psoriasis and targeted by biologics have also been identified in patients with depression. It is therefore thought that anti-cytokine therapies may improve patients’ quality of life not only by reducing their disease burden but also by modulating the inflammatory pathways implicated in depression. While depression is mentioned in the package inserts of brodalumab and apremilast, only brodalumab has a black box warning requiring discussion of suicidality prior to prescribing the drug. In clinical trials, the majority of patients receiving brodalumab experience a reduction in symptoms of depression and anxiety. The package insert for brodalumab points out that no causal association has been established between brodalumab and suicide, and the FDA-mandated Risk Evaluation and Mitigation Strategies (REMS) program for brodalumab takes only minutes to complete. Brodalumab and apremilast may therefore be considered for patients in whom depression is caused by psoriasis, provided that patients and their providers have a mutual understanding of the risks and benefits of these therapies and the REMS program is followed.

Psoriasis and Depression: The Role of Inflammation

Psoriasis is a chronic, systemic inflammatory disorder with multiple comorbidities.The most common comorbidities are mental disorders, especially depression, which can interact negatively with psoriasis to produce a dangerous vicious circle. Depression in psoriasis has traditionally been explained as a response to psychosocial factors and impaired quality of life.However, a new hypothesis linking depression and psoriasis through chronic inflammation offers insights that should help us to understand and treat these diseases. In this approach, new drugs and lifestyle have an important role.

Psoriasis y depresión: el papel de la inflamación

Psoriasis is a chronic, systemic inflammatory disorder with multiple comorbidities.The most common comorbidities are mental disorders, especially depression, which can interact negatively with psoriasis to produce a dangerous vicious circle. Depression in psoriasis has traditionally been explained as a response to psychosocial factors and impaired quality of life.However, a new hypothesis linking depression and psoriasis through chronic inflammation offers insights that should help to understand and treat these diseases. In this approach, new drugs and lifestyle have an important role.

Psoriasis, Depression, and Inflammatory Overlap: A Review.

Psoriasis has an enormous impact on patients' lives and is frequently associated with depression. Depression in psoriasis may be attributed, at least in part, to elevated proinflammatory cytokines rather than the psychosocial impact of psoriasis itself. Biologics that target inflammatory cytokines treat the clinical manifestations of psoriasis, but may also play a role in reducing associated depression. Multiple biologics have decreased symptoms of depression during clinical trials in psoriasis; however, these studies used a variety of depression screening tools, which limits comparison. Furthermore, it is difficult to distinguish whether improved depression is the result of the direct anti-inflammatory effect of the biologic, or the indirect effect of improved psoriasis leading to better psychological status. Future studies evaluating depression in patients with psoriasis could benefit from a standardized depression screening tool to mitigate discrepancies and facilitate comparison across treatment types. Here, we highlight the inflammatory overlap between psoriasis and depression by examining the pathophysiology of depression, and reviewing psoriasis clinical studies that assessed depression as an outcome measure.

Self-reported depression in psoriasis is associated with subclinical vascular diseases

Background and aimsPsoriasis is a chronic inflammatory disorder associated with vascular inflammation, measured by 18-fluorodeoxyglucose positron emission tomography/computed tomography (18-FDG PET/CT), and an increased risk of myocardial infarction. Patients with psoriasis are also more likely to suffer from comorbid depression. Whether depression accelerates the development of subclinical atherosclerosis in psoriasis is unknown. MethodsPatients were selected from within a larger psoriasis cohort. Those who reported a history of depression (N = 36) on survey were matched by age and gender to patients who reported no history of psychiatric illness (N = 36). Target-to-background ratio from FDG PET/CT was used to assess aortic vascular inflammation and coronary CT angiography scans were analyzed to determine coronary plaque burden. Multivariable linear regression was performed to understand the effect of self-reported depression on vascular inflammation and coronary plaque burden after adjustment for Framingham risk (standardized β reported). ResultsIn unadjusted analyses, vascular inflammation and coronary plaque burden were significantly increased in patients with self-reported depression as compared to patients with psoriasis alone. After adjustment for Framingham Risk Score, vascular inflammation (β = 0.26, p = 0.02), total plaque burden (β = 0.17, p = 0.03), and non-calcified burden (β = 0.17, p = 0.03) were associated with self-reported depression. ConclusionsSelf-reported depression in psoriasis is associated with increased vascular inflammation and coronary plaque burden. Depression may play an important role in promoting subclinical atherosclerosis beyond traditional cardiovascular risk factors.

Psoriasis and New-onset Depression: A Danish Nationwide Cohort Study

Psoriasis is associated with an increased risk of depression, but results are inconsistent. This study examined the risk of new-onset depression in patients with psoriasis in a nationwide Danish cohort including some 5 million people in the period 2001-2011. A total of 35,001 patients with mild psoriasis and 7,510 with severe psoriasis were identified. Incidence rates per 1,000 person-years and incidence rate ratios (IRRs) were calculated. Incidence rates for depression were 20.0 (95% confidence interval 19.9-20.0), 23.9 (23.1-24.7) and 31.6 (29.5-33.8) for the reference population, mild, and severe psoriasis, respectively. Adjusted for age, sex, and inclusion year, IRRs were 1.08 (1.04-1.12) in mild and 1.36 (1.27-1.46) in severe psoriasis. After adjustment for comorbidity, the IRR was significant in only patients < 50 years with severe psoriasis (IRR 1.23 (1.03-1.46)). In conclusion, the risk of new-onset depression in psoriasis is mediated primarily by comorbidities, except in younger individuals with severe psoriasis, in whom psoriasis itself may be a risk factor.

Impact of fumaric acid esters on cardiovascular risk factors and depression in psoriasis: a prospective pilot study.

Patients with psoriasis have an increased risk of cardiovascular disease that is partly attributable to chronic systemic inflammation. The aim of our prospective pilot study was to investigate the impact of fumaric acid esters (FAE), a first-line systemic antipsoriatic treatment in Germany, on cardiovascular risk parameters. Participants with moderate-to-severe psoriasis from the University Medical Center Mannheim and the University Hospital Würzburg were treated with FAE for 16 weeks according to standard dosage recommendations. Disease severity, life quality and depression scores as well as biomarkers of inflammation, lipid and glucose metabolism were assessed prior to initiation of FAE and after 16 weeks. Out of 39 participants recruited, 27 completed the study. 44% of all participants and 63% of those completing the 16-week treatment achieved PASI 50 response and 27 or 37% PASI 75 response. Clinical improvement was paralleled by significant improvement in quality of life, high treatment satisfaction and significant reduction of depressive symptoms. Adverse events, most frequently mild gastrointestinal complaints, flush and lymphocytopenia occurred in 89%. FAE did not modify glucose metabolism or inflammatory parameters substantially. However, a highly significant increase in serum levels of the atheroprotective cytokine adiponectin was noted after 16 weeks (median 4.7 vs. 8.9 µg/ml; p = 0.0002). Our study demonstrates a significant beneficial impact of FAE on adiponectin, indicating a potential cardioprotective effect. It will be interesting to verify this finding in larger cohorts and to assess the long-term influence of FAE on cardiovascular risk and disease.

The Prevalence and Odds of Depressive Symptoms and Clinical Depression in Psoriasis Patients: A Systematic Review and Meta-Analysis

The reported prevalence of depression in psoriasis varies substantially. This study aims to determine the prevalence and odds of depressive symptoms and clinical depression in psoriasis. A systematic literature search was conducted. Mean questionnaire values and proportions for depressive symptoms and clinical depression were pooled according to different assessment methods. In controlled studies, standardized mean differences (SMDs) and odds ratio (OR) compared depression in psoriasis patients with controls using the random-effect model. The majority of the 98 eligible studies were conducted in tertiary centers without a control group. The prevalence of depressive symptoms was 28% using questionnaires and the prevalence of clinical depression was 12% using International Classification of Diseases codes, 19% using Diagnostic and Statistical Manual of Mental Disorders IV, and 9% for antidepressant use. Psoriasis patients had significantly more depressive symptoms (SMD 1.16; 95% confidence interval (CI) 0.67-1.66), and population-based studies showed that they were at least one and a half times more likely to experience depression (OR 1.57; 95% CI 1.40-1.76) and used more antidepressants than did controls (OR 4.24, 95% CI 1.53-11.76). More than 10% of psoriasis patients suffer from clinical depression, and twice as many have depressive symptoms. The high prevalence of these symptoms is likely to be affected by the tertiary study populations and differential misclassification using questionnaires, where psoriasis-related symptoms may be detected as depressive symptoms.

Psychological differences between early- and late-onset psoriasis: a study of personality traits, anxiety and depression in psoriasis

Onset of psoriasis may occur at any age. Early negative experiences often influence personality development, and may lead to physical disease, anxiety and depression in adulthood. Knowledge about onset of psoriasis and psychopathology is limited. To examine whether patients with early-onset psoriasis differ psychologically from patients with late-onset psoriasis, regarding personality traits, anxiety and depression. A descriptive cross-sectional study was conducted among 101 consecutively recruited outpatients with psoriasis. A psychosocial interview was performed followed by self-assessment of validated questionnaires: Swedish Universities Scales of Personality (SSP), Spielberger State-Trait Anxiety Inventory and Beck Depression Inventory. Psoriasis severity was assessed by the Psoriasis Area and Severity Index. Patients with early-onset psoriasis (age < 20 years) were significantly more anxious and depressed than patients with late-onset psoriasis. In multiple linear regression models, younger age at onset of psoriasis was a significant determinant of higher scores of four personality traits: SSP-embitterment, -trait irritability, -mistrust and -verbal trait aggression. Our results indicate that early detection of psychological vulnerability when treating children and adolescents with psoriasis seems to be of great importance. Traits of psychological vulnerability and pessimistic personality traits were found to be significantly associated with the early onset of psoriasis, but not with disease duration in this study. These traits may be seen as a consequence of psoriasis, and/or as individual traits modulating and impairing clinical course and efforts to cope with psoriasis.

Does Concomitant Use of NSAIDs Reduce the Effectiveness of Antidepressants?

Does Concomitant Use of NSAIDs Reduce the Effectiveness of Antidepressants?

Relationship between anger and pruritus perception in patients with chronic idiopathic urticaria and psoriasis

There is evidence that chronic idiopathic urticaria (CIU) and psoriasis are associated with personality based difficulties in emotional regulation particularly with regard to the feeling of anger. This deficit in emotional awareness could lead to the phenomenon that emotions are rather experienced in bodily symptoms such as pruritus. We investigated whether there is a relationship between pruritus as major symptoms in CIU and psoriasis and the experience of negative emotions. Forty-one CIU patients and 44 psoriasis patients treated at Bonn University Hospital and 49 healthy controls were included. Patients and controls were compared on questionnaires measuring alexithymia (TAS-20), emotional distress (SCL-90-R) and anger (STAXI). In skin-disordered patients, separate stepwise regressions with pruritus severity as dependent variable and questionnaires, skin status, duration, sex and age as independent variables were calculated. CIU and psoriasis patients showed higher alexithymia, emotional distress, depression, anxiety and state anger compared with controls. State anger was the only significant predictor of pruritus severity in CIU explaining 19% of variance. Depression was the only significant predictor of pruritus severity in psoriasis explaining 12% of variance. Our findings suggest a relationship between pruritus severity and anger in CIU. Furthermore, our results indicate a relationship between pruritus severity and depression in psoriasis.

Potential Drugs for Improving Chronic Fatigue Syndrome

Back to table of contents Previous article Next article LETTERFull AccessPotential Drugs for Improving Chronic Fatigue SyndromeSayed Shahabuddin Hoseini,Shahriar Gharibzadeh,Sayed Shahabuddin HoseiniSearch for more papers by this author,Shahriar GharibzadehSearch for more papers by this author,Published Online:1 Oct 2007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Chronic fatigue syndrome (CFS) is the current name for a disorder Characterized by debilitating fatigue and several associated physical, constitutional, and neuropsychological complaints. Specific symptoms reported by CFS patients are fatigue, difficult concentration, headache, sore throat, tender lymph node, muscle ache, joint ache, feverishness, and allergies. There are several hypotheses about its etiology, including postinfectious, immunological, neuroendocrine, neurological, and psychological ones. A CNS dysfunction brought about by abnormal cytokine release in response to antigenic challenge has been described. 1 Substantial evidences show a pivotal role for proinflammatory Cytokines (e.g., interleukin1, interleukin6, and tumor necrosis factor-α) in induction of CNS mediated responses such as fever, somnolence, and sickness behavior in acute infections. A significant elevation in serum levels of interleukin-1, and tumor necrosis factor-α in the patient with chronic fatigue syndrome have been reported. 2Recently, biological agents that bind and neutralize the tumor necrosis factor have become available: 1) Etanercept, a tumor necrosis factor type 2 receptor fused to IgG1, is assessed to be effective in psoriasis. 32) Infliximab, a chimeric mouse-human monoclonal antibody to the tumor necrosis factor, has shown successful trials for treating inflammatory bowel disease.3) Adalimumab, a fully human antibody to the tumor necrosis factor, is used in cutaneous sarcoidosis. 4) Thalidomide has immunomodulatory and anti-inflammatory effects including inhibition of synthesis of the tumor necrosis factor –α. It is effective for treating Behçets syndrome. 4 We suggest that these drugs, which are approved by FDA for some of the aforementioned diseases, can be useful in treating patients with chronic fatigue syndrome. Even modest improvement in symptoms can make an important difference in the patient’s degree of self-sufficiency and ability to appreciate life’s pleasures. 5 Surely, clinical trials should be done to assess the efficacy versus side effects of these drugs on affected patients. Faculty of Medicine, Medical Sciences/Tehran University, Tehran, IranNeuromuscular Systems Laboratory, Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, IranReferences1 . Mihrshahi R, Beirman R: Etiology and pathogenesis of chronic fatigue syndrome: a review. N Z Med J 2005; 118:U1780Google Scholar2 . Tomoda A, Joudoi T, Rabab el-M, et al: Cytokine production and modulation: comparison of patients with chronic fatigue syndrome and normal controls. Psychiatry Res 2005; 134:101–104Google Scholar3 . Bos JD, de Korte J: Effects of etanercept on quality of life, fatigue, and depression in psoriasis. Lancet 2006; 367:6–7Google Scholar4 . Sayarlioglu M, Kotan MC, Topcu N, et al: Treatment of recurrent perforating intestinal ulcers with thalidomide in Behcet’s disease. Ann Pharmacother 2004; 38:808–811.Google Scholar5 . Straus SE: Chronic fatigue syndrome, in Harrison’s Textbook of Internal Medicine, 16th ed. New York, McGraw-Hill, 2005, pp 2545–2547Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 19Issue 4 Fall, 2007Pages 472-472 Metrics PDF download History Published online 1 October 2007 Published in print 1 October 2007

Potential Drugs for Improving Chronic Fatigue Syndrome

Back to table of contents Previous article Next article LETTERFull AccessPotential Drugs for Improving Chronic Fatigue SyndromeSayed Shahabuddin Hoseini,Shahriar Gharibzadeh,Sayed Shahabuddin HoseiniSearch for more papers by this author,Shahriar GharibzadehSearch for more papers by this author,Published Online:1 Oct 2007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Chronic fatigue syndrome (CFS) is the current name for a disorder Characterized by debilitating fatigue and several associated physical, constitutional, and neuropsychological complaints. Specific symptoms reported by CFS patients are fatigue, difficult concentration, headache, sore throat, tender lymph node, muscle ache, joint ache, feverishness, and allergies. There are several hypotheses about its etiology, including postinfectious, immunological, neuroendocrine, neurological, and psychological ones. A CNS dysfunction brought about by abnormal cytokine release in response to antigenic challenge has been described. 1 Substantial evidences show a pivotal role for proinflammatory Cytokines (e.g., interleukin1, interleukin6, and tumor necrosis factor-α) in induction of CNS mediated responses such as fever, somnolence, and sickness behavior in acute infections. A significant elevation in serum levels of interleukin-1, and tumor necrosis factor-α in the patient with chronic fatigue syndrome have been reported. 2Recently, biological agents that bind and neutralize the tumor necrosis factor have become available: 1) Etanercept, a tumor necrosis factor type 2 receptor fused to IgG1, is assessed to be effective in psoriasis. 32) Infliximab, a chimeric mouse-human monoclonal antibody to the tumor necrosis factor, has shown successful trials for treating inflammatory bowel disease.3) Adalimumab, a fully human antibody to the tumor necrosis factor, is used in cutaneous sarcoidosis. 4) Thalidomide has immunomodulatory and anti-inflammatory effects including inhibition of synthesis of the tumor necrosis factor –α. It is effective for treating Behçets syndrome. 4 We suggest that these drugs, which are approved by FDA for some of the aforementioned diseases, can be useful in treating patients with chronic fatigue syndrome. Even modest improvement in symptoms can make an important difference in the patient’s degree of self-sufficiency and ability to appreciate life’s pleasures. 5 Surely, clinical trials should be done to assess the efficacy versus side effects of these drugs on affected patients. Faculty of Medicine, Medical Sciences/Tehran University, Tehran, IranNeuromuscular Systems Laboratory, Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, IranReferences1 . Mihrshahi R, Beirman R: Etiology and pathogenesis of chronic fatigue syndrome: a review. N Z Med J 2005; 118:U1780Google Scholar2 . Tomoda A, Joudoi T, Rabab el-M, et al: Cytokine production and modulation: comparison of patients with chronic fatigue syndrome and normal controls. Psychiatry Res 2005; 134:101–104Google Scholar3 . Bos JD, de Korte J: Effects of etanercept on quality of life, fatigue, and depression in psoriasis. Lancet 2006; 367:6–7Google Scholar4 . Sayarlioglu M, Kotan MC, Topcu N, et al: Treatment of recurrent perforating intestinal ulcers with thalidomide in Behcet’s disease. Ann Pharmacother 2004; 38:808–811.Google Scholar5 . Straus SE: Chronic fatigue syndrome, in Harrison’s Textbook of Internal Medicine, 16th ed. New York, McGraw-Hill, 2005, pp 2545–2547Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 19Issue 4 Fall, 2007Pages 472-472 Metrics PDF download History Published online 1 October 2007 Published in print 1 October 2007

Tumor Necrosis Factor Blockade: Mechanism of Action

Modulation of the immune response with tumor necrosis factor (TNF) blockers is not a new treatment strategy for many inflammatory disorders; however, relatively little is known about their specific mechanism of action. Understanding the mode of action, pharmacology, and pharmacokinetics of the monoclonal TNF antibodies, infliximab and adalimumab, and the soluble TNF receptor, etanercept, may therefore enable us to account for their differing clinical profiles. The aim of this supplement is to explore the roles and mechanisms of TNF and TNF blockade using in vitro pharmacological and in vivo animal modeling experiments, and in vivo studies of the effects of etanercept on the inflammatory cascade in patients with psoriasis.