Mood disorders linked to biologic initiation, switching in rheumatic diseases
medwireNews: Depression and anxiety are significantly associated with the introduction and switching of biologic DMARDs in patients with inflammatory rheumatic diseases (IRDs), population-based study data show.
“Although a causal relationship is uncertain, the impact of depression and anxiety should always be considered by physicians facing the decision to introduce or switch [biologic] DMARDs in patients with active IRDs,” write Vasiliki-Kalliopi Bournia (National and Kapodistrian University of Athens, Greece) and co-authors in RMD Open.
The study included data for 42,815 patients with IRDs from a Greek national database, of whom 23,890 initiated or continued biologic DMARDs, most commonly tumor necrosis factor inhibitors, between 2016 and 2018. The remainder were treated with conventional DMARDs alone, typically methotrexate.
Of the 27,462 patients with rheumatoid arthritis (RA), 24% were using antidepressant medication and 43% were using anxiolytic medication. The corresponding proportions were 19% and 36% among the 8469 patients with psoriatic arthritis (PsA) and 16% and 30% among the 6883 patients with ankylosing spondylitis (AS).
After adjustment for age, sex, underlying disease, and glucocorticoid, biologic DMARD, and conventional DMARD use, the researchers found that compared with PsA patients, those with RA were significantly less likely to receive antidepressants (odds ratio [OR]=0.88), whereas those with AS were significantly more likely to be taking these agents (OR=1.13).
Similarly, patients with RA were significantly less likely to use anxiolytics than those with PsA (OR=0.82), but there was no difference in rates of use between the patients with AS and those with PsA, after adjustment for potential confounders.
Further analysis revealed that people using antidepressant or anxiolytic medication were significantly more likely to initiate biologic DMARD treatment than those not taking these drugs, at ORs of 1.25 and 1.18, respectively.
They were also more significantly likely to switch biologic DMARDs, with corresponding adjusted ORs of 1.50 and 1.16.
Bournia et al suggest that “depression and anxiety […] may contribute to [biologic] DMARD initiation and switching in these patients, either by aggravating disease severity and/or by distorting the perception of patient-reported outcome measures.”
They conclude: “Mood disorders should be always considered by practicing rheumatologists upon the decision to propose to an ‘inadequately treated’ patient the introduction or switching of a biologic agent.
“Whether the same holds true for patients with psoriasis and inflammatory bowel disease needs further investigation.”
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