P-087 YI Improvement of Anxiety and Depression Rates After 1 Year Treatment with Anti-TNF Agents in Patients with Inflammatory Bowel Disease

Abstract

Background: Inflammatory bowel disease (IBD) is characterized by a chronic relapsing inflammation of the gastrointestinal tract. The major subtypes are Crohn's disease (CD) and ulcerative colitis (UC). The symptoms can have significant psychosocial implications that can impact the health-related quality of life (HRQoL). Anxiety and depression can affect quality of life in IBD patients and can interfere on the adherence to treatment. An ambitious goal of treatment is to achieve normalization of HRQoL. Anti-TNF agents are not only effective at inducing remission but have also been shown to improve HRQoL. Given the importance of restoration of health and improvement of HRQoL in IBD patients, the purpose of the present study was to determine the impact of 1 year of treatment with anti-TNF agents on the improvement of anxiety and depression rates and identify predictors of anxiety and depression during the treatment. Methods: A prospective, longitudinal study was performed on patients with Crohn's disease or ulcerative colitis treated with anti-TNF agents. Biological treatment was indicated for patients with refractory disease to corticosteroids or immunosuppressants and for patients with perianal fistula. Five patients had prior exposure to anti-TNF agents. The inflammatory bowel disease questionnaire (IBDQ) was used to measure the HRQoL at baseline and at weeks 14, 30, and 54. The hospital anxiety and depression scale (HADS) was used to measure anxiety and depression. The Crohn's Disease Activity Index (CDAI) was used to assess the clinical response of CD patients. Mayo score was used to assess the clinical response of UC patients. Statistical Analysis: Variables were analyzed at 4 time points using variance analysis of repeated measurements (ANOVA) with the Tukey post-test. Logistic regression models were performed to identify predictors of anxiety and depression. Results: Thirty-five patients were included in this study. Seventy-seven percent of the patients had CD, and 23% had UC. Biologic anti-TNF treatment included adalimumab in 12 patients and infliximab in 23 patients. Forty-four percent of the CD patients had perianal disease. Clinical response was achieved in 24 patients (18 with CD and 6 with UC, P = 1.0). All patients who achieved clinical response during follow-up also showed improved HRQoL. The mean score for HADS during follow-up ranged from 8.1(+/-4.5) points at treatment week 0 to 3.7 (+/-3.0) at week 54 for anxiety (P < 0.0001) and from 6.2 (+/-3.9) points at week 0 to 2.6 (+/-2.6) points at week 54 for depression (P <0.0001). According to the logistic regression models gender female (OR: 9.75; 95% CI: 1.382-68.782; P = 0.02), surgery (OR: 0.071; 95% CI: 0.007-0.770; P = 0.02) and absence of clinical response (OR: 56.0; 95% CI: 4.360-719.204; P = 0.002) were associated with anxiety at treatment week 54. Surgery (OR: 0.094; 95% CI: 0.012-0.764; P = 0.02) and absence of clinical response (OR: 29.9; 95% CI: 2.58-348.74; P = 0.006) were associated with depression at treatment week 54. Conclusions: Clinical response to anti-TNF agents is associated with improvement in HRQoL in IBD patients, besides improvement of anxiety and depression rates. Absence of clinical response was associated with anxiety and depression.