SAT0334 DOES DEPRESSION PREDICT FUTURE DISEASE STATUS AND IMPROVEMENTS IN DISEASE PARAMETERS? RESULTS FROM THE COMPLETE STUDIES, A CANADIAN REAL WORLD OBSERVATIONAL COHORT

Abstract

Background: Depression is a common comorbidity in rheumatic diseases such as Psoriatic Arthritis (PsA) and Ankylosing Spondylitis (AS), whereby it is associated with increased disease activity, decreased functionality, and lower persistence with treatment. Objectives: The objective of this analysis was to assess if baseline depression in Canadian patients with PsA or AS predicts future disease status and improvement in disease parameters. Methods: COMPLETE is a Canadian observational cohort of anti-TNFa naïve adults with PsA and AS, who require a change in their treatment. Separate analyses were performed for each disease group. Depression was defined as BDI score ≥20 (or use of anti-depressants and/or anxiolytic medication). Multivariate logistic regression was used to assess the baseline predictors of achievement of low disease activity (LDA) in BASDAI (<4) and BASFI (<4) for patients with AS; or DAPSA LDA (≤13), DAS28 LDA (<3.2), DAPSA remission (≤4), DAS28 remission (<2.6) and BSA <3% for patients with PsA. The maximum improvement (highest change from baseline at either 6 or 12 months) in BASDAI, BASFI, DAPSA, DAS28 was assessed for using multivariate linear regression and the least square means (LSMs). The maximum improvement in HAQ-DI and SF-12 physical component scale (PCS) and mental component scale (MCS) were also assessed among PsA patients. Results: A total of 492 patients with AS and 333 with PsA had BDI assessments (or criteria for depression) at baseline and were included in the analysis; mean (SD) age was 42.7 (13.2) and 51.5 (12.2) years, respectively. Patients with AS were mostly male (54.1%) and initiated adalimumab treatment (70.9%) with mean (SD) disease duration of 5.4 (9.1) years; for PsA, sex was evenly distributed (female 50.5%), 66.4% initiated treatment with adalimumab and mean (SD) disease duration was 14.7 (13.7) years. The prevalence of depression at baseline was 24.6% and 25.5% in patients with AS and PsA, respectively. Upon adjusting for potential confounders, presence of depression in patients with AS was associated with significantly lower odds of achieving BASDAI LDA (OR: 0.51, p=0.021) and BASFI LDA (OR: 0.52, p=0.045) during treatment. In these analyses, positive HLA B27 status was also identified as a significant positive predictor of either outcome (ORBASDAI LDA: 1.91, p=0.016; ORBASFI LDA: 1.98, p=0.029), while older age was identified as a negative predictor of BASFI LDA achievement (OR: 0.98, p=0.044). Similarly, patients with depression experienced significantly lower improvements in BASDAI (LSM:-1.72 vs.-2.44; p=0.007), and BASFI scores (-1.46 vs.-2.02; p=0.029) compared to those without depression. Among patients with PsA, presence of depression appeared to be associated with lower odds of achieving DAPSA remission (OR: 0.35, p=0.070). No association was observed between presence of depression and DAPSA LDA, DAS28 LDA or remission, and BSA<3%. In terms of disease improvement, significant lower improvement in DAPSA score (LSM:-11.00 vs.-14.66; p=0.047) and SF-12 MCS (LSM:-3.01 vs. 4.36; p=0.007) were observed among patients with depression. Conclusion: A significant proportion of AS and PsA patients suffer from depression. Baseline depression seems to negatively affect treatment outcomes in both AS and PsA patients. Whether this is due to differences in the assessment of patient-reported outcomes or due to physiological differences remains to be confirmed.