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

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.