P-091 YI Predictors of Health-Related Quality of Life in Patients with Inflammatory Bowel Disease After 1 Year with Anti-TNF Agents

Abstract

Background: Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), impairs patients' health-related quality of life (HRQoL). 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. The purpose of the present study was to determine the impact of 1 year of anti-TNF treatment on the HRQoL of IBD patients and to identify predictors of good to excellent HRQoL. 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 Crohn's Disease Activity Index (CDAI) was used to assess the clinical response of CD patients. We considered patients in long-term clinical remission if the CDAI was less than 150 through week 54 from the start of biologic anti-TNF treatment. Mayo score was used to assess the clinical response of UC patients. Clinical remission was defined as a total Mayo score of 2 points or lower, with no individual subscore exceeding 1 point. 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 good or excellent HRQoL. The study was approved by the local Research Ethics Committee and written informed consent was obtained from all subjects before inclusion. 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). There was no association between clinical response and the following variables: age (P = 0.28), gender (P = 0.09), disease duration (P = 0.08), smoking status (P = 0.73) and biologic anti-TNF treatment (infliximab/adalimumab, P = 1.0). There was an association between clinical response and surgery (P = 0.001). All patients who achieved clinical response during follow-up also showed improved HRQoL. Gender female (OR: 0.038; 95% CI: 0.003-0.446; P = 0.009), depression (OR: 0.024; 95% CI: 0.002-0.317; P = 0.004) and without clinical response (OR: 0.053; 95% CI: 0.005-0.596; P = 0.017) were associated with good/excellent HRQoL. Conclusions: Clinical response to anti-TNF agents is associated with improvement in HRQoL in IBD patients. Predictors of good or excellent HRQoL were gender male, absence of depression and without clinical response.