Background Depression is widely reported in RA, with prevalence estimates at 14-46%. Several studies have suggested that RA patients with persistent depression have poorer response to anti-TNF therapy.
Objectives To investigate the effects of depression status at baseline in patients with RA on (1) response to anti-TNF therapy at 6 months, and (2) survival rates on first anti-TNF drug.
Methods 8899 patients with RA starting their first anti-TNF and enrolled in the BSRBR were included in this analysis. Data was collected at baseline and 6 monthly for 3 years from the hospital (including 28 joint count disease activity score (DAS28)), comorbidity, anti-rheumatic drug use (start/stop dates and reasons for discontinuation) and current medication use) and the patients (Health Assessment Questionnaire (HAQ)). Depression was defined at baseline as no history (ND), depression history without current medication (D), or depression with current medication (CM). Response to anti-TNF at 6-months was defined using (1) EULAR response criteria (none versus moderate or good) and (2) achieving >0.22 improvement in HAQ. Multivariate logistic regression was used to study the effect of depression on response. Discontinuation of anti-TNF was compared using Cox Regression.
Results Depressed patients were younger, proportionally more female with similar disease severity (Table). Co-morbidity rates were higher in depressed patients, particularly those taking medication. There was no difference in overall DAS28 response between the groups. However, depressed patients were less likely to achieve a clinically significant improvement in HAQ. Survival rates on drug were not affected by depression D HR 1.01 (0.92, 1.12) CM HR 1.00 (0.88, 1.13).
Conclusions Patients with baseline depression were less likely to achieve a clinically important improvement in HAQ at 6 months, with no difference in DAS28 response, suggesting it may be subjective measures of disease and ultimately response that are affected by patient depression. Drug survival was not affected by depression suggesting that anti-TNF therapy is still effective in these patients.
Disclosure of Interest None Declared
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