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Abstract
Background Potential side effects of biologic drugs may increase the anxiety levels of patients and influence their desire to use these therapies and compliance to treatment considerably.
Objectives The aim of this study was to determine the level and prevalence of anxiety in patients treated with biologic agents and to have more information about causes of drug-related concerns.
Methods Patients who were using biologic agents (adalimumab, etanercept, golimumab, infliximab and rituximab) at least for 3 months with the diagnosis of rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) were enrolled to the study. The demographic features, disease and biologic usage duration, previous biologic treatments and treatment side effects were recorded with a specific form. General anxiety levels were evaluated with state and trait anxiety inventory (STAI). Patients' anxiety levels about their biological treatments were evaluated with visual analog scale (0-10 cm) and multiple-choice questions were asked to determine their thoughts related to the drug side effects.
Results A total of 411 patients (217 female-52.8% and 194 male-47.2%) with the diagnosis of RA (n:132), AS (n:239) and PsA (n: 40) were enrolled to the study. 69.6% of patients stated that they have concerns about medication and its side effects. The most common cause about the drug-related concern was potential side effects of the drugs (67.9%). Among the potential side effects, cancer risk (45.5%) was the most common cause and tuberculosis activation risk (24.8%) was the second common cause of concern. Patients' feelings and thoughts about the drug during the treatment initiation were also effective on the current anxiety levels. Patients with negative feelings had higher anxiety levels than those with positive (p=0.001) or neutral (p=0.001) feelings. Anxiety levels were higher in patients who experienced side effects than others and this difference was statistically significant (p=0.001). STAI trait and state scores was moderately correlated with anxiety levels related to drug (p=0.001 r =0.264, p=0.001 r =0.353, respectively). In patients with high levels of anxiety, either state or trait anxiety levels were higher.
Conclusions Our findings suggest that, anxiety related to biologic agents may significantly affect the patients' psychology and may lead to chronic anxiety and depression. Awareness about the patients' concerns and expectations related to drug is very important to ensure drug adherence and compliance to treatment. Detailed information about the risk of cancer and tuberculosis, which were the most frequent cause of drug-related concerns, can provide a significant reduction in patients' anxiety levels. Information obtained from this study may help to increase our knowledge about the concerns of patients related to biologic agents. Thus, patient-physician communication and patients' compliance to physicians' guidance will be the two major area of focus.
References
Marshall NJ, Wilson G, Lapworth K, Kay LJ. Patients' perceptions of treatment with anti-TNF therapy for rheumatoid arthritis: a qualitative stud, Rheumatology. 2004 Aug;43(8):1034-8. Epub 2004 May 18.
Arkell P, Ryan S, Brownfield A, Cadwgan A, Packham J. Patient experiences, attitudes and expectations towards receiving information about anti-TNF medication – “It could give me two heads and I'd still try it!”. BMC Musculoskelet Disord. 2013 May 10;14:165.
Disclosure of Interest None declared