Signs of Depression Linked to mAb Therapy Nonresponse in Patients With Severe Asthma

In a study of patients with severe asthma treated with monoclonal antibody (mAb) therapy, those with symptoms of depression prior to therapy initiation showed less mAb therapy response compared with the general population, and patients whose psychological symptoms were due to severe asthma showed less symptoms after effective asthma treatment.

The findings were published in the Journal of Asthma and Allergy.

“Patients that respond to mAb-therapy exhibit lower levels of MDD [Major Depressive Disorder]- or GAD [General Anxiety Disorder]-related symptoms and prevalence of probable MDD and GAD decreased significantly after initiation of mAb-therapy,” the study authors wrote. “Logistic regression analysis revealed pre-existing symptoms of depression as a major predictor for nonresponse to mAb-therapy.”

To the researchers’ knowledge, this single-center, retrospective analysis is the first of its kind to examine the possible relation between mAb therapy and mental health, as well as predict mAb nonresponse or decline in mental health status.

Asthma is a chronic condition known to be associated with a high prevalence of mental health disorders, especially depression and anxiety. Although previous research has shown an improvement in self-reported outcomes for anxiety and depressive symptoms among patients with asthma under mAb therapy, a significant number of patients with severe asthma do not respond to mAb therapy.

The study included a total of 82 patients with uncontrolled severe asthma, as defined by the American Thoracic Society and the European Respiratory Society guidelines. Additional data collected included age, sex, body mass index (BMI), smoking status, alcohol consumption, pollution exposure, education attainment, etc.

All patients received treatment for asthma, including medium to high-dose inhaled glucocorticoids and a long-acting β2-agonist. Additionally, patients could receive a second or third controller and/or additional oral corticosteroids therapy, such as mepolizumab, benralizumab, dupilumab, or omalizumab.

Using GAD and MDD questionnaires, the researchers collected data on the patients during routine appointments between March 2020, to March 2022. Follow-up was conducted 3 to 9 months after treatment.

A total of 38 (46%) patients undergoing mAb treatment in the study cohort exhibited probable MDD and/or GAD. At the time of initiation, 53% of patients showed signs of probable psychological problems, which the authors noted suggests the prevalence of such symptoms is higher among patients with sever asthma vs the general population in Germany, where the study was conducted.

A total of 61 (74%) patients responded to treatment, and 21 (26%) did not respond to treatment. Furthermore, 24 (39%) responders showed probable MDD and/or GAD compared with 14 (67%) non-responders (P = .030).

"Patients that respond to mAb-therapy exhibit lower levels of MDD- or GAD-related symptoms and prevalence of probable MDD and GAD decreased significantly after initiation of mAb-therapy," the authors wrote. "Logistic regression analysis revealed pre-existing symptoms of depression as a major predictor for non-response to mAb-therapy."

The analysis also showed that patients who responded to mAb therapy experienced improved quality of life, less exacerbations, better lung function, and improved management and control of their asthma compared with patients who did not respond to treatment.

The researchers acknowledge some limitations to the study, including it being retrospective and including a small sample size within a single center. Other limitations include using GAD and MDD scores to select patients for follow-up and did not include a mental disorder diagnosis.

Despite these limitations, the researchers believe that the study suggests mental health may play a part in the responsiveness to mAb therapy for patients with severe asthma and may be a predictor for understanding the appropriate treatment pathway for patients with severe asthma and mental health disorders.

“Taken together, our findings highlight the need for a subsequent psychiatric evaluation in patients suffering most probably from mental disorders and severe asthma as well as for further research regarding possible causal connections between asthma and mental diseases,” wrote the researchers.

Reference

Plank PM, Hinze CA, Campbell V, et al. Relationship between the response to antibody therapy and symptoms of depression and anxiety disorders in patients with severe asthma. Journal of Asthma and Allergy. 2023;Volume 16:421-431. doi:10.2147/jaa.s403296