Depression, anxiety may disrupt biologic therapy persistence in IBD

The presence of anxiety and mood disorders (AMD) appears to interfere with treatment adherence among inflammatory bowel disease (IBD) patients initiating anti-tumour necrosis factor (anti-TNF) therapy, a study has found.

The study included 1,135 IBD patients receiving anti-TNF therapy, of whom 178 (15.7 percent) met the diagnostic criteria for AMD in the 2 years prior to treatment initiation. There were more female patients in the AMD than in the non-AMD group (70 percent vs 48 percent; p<0.0001).

In Cox proportional hazards multivariable regression models, the risk of anti-TNF therapy discontinuation was high in the presence of AMD (hazard ratio [HR], 1.28, 95 percent confidence interval [CI], 1.03–1.59).

Discontinuation of anti-TNF medication within the first year was documented in 44 percent of patients in the AMD group vs 34 percent in the non-AMD group (p=0.008). Indeed, AMD strongly predicted medication withdrawal within the first year of initiation (HR, 1.50, 95 percent CI, 1.15–1.94). Having Crohn’s disease was also associated with a higher risk of non-persistence of treatment.

Gender did not modify the association between AMD and treatment persistence (female x AMD: HR for interaction term, 1.32, 95 percent CI, 0.85–2.05; p=0.62)

The present data suggest that concomitant AMD have less to do with adversely affecting the course of IBD and more to do with interrupting the ongoing use of anti-TNF, according to the researchers. More studies are needed to confirm the findings, as well as to assess the benefits of targeted screening and interventions for AMDs in IBD patients about to start biologic therapy.