Depressive Symptoms Predict Anti-tumor Necrosis Factor Therapy Noncompliance in Patients with Inflammatory Bowel Disease.

Abstract

BACKGROUND:

Noncompliance in use of anti-tumor necrosis factor (anti-TNF) therapy in patients with moderate-to-severe inflammatory bowel disease (IBD) can be a factor in medication failure. Few studies have evaluated the contribution of depressive symptoms to medication noncompliance in anti-TNF therapies.

METHODS:

A retrospective chart review was performed in a single-center tertiary care IBD center for patients with Crohn's disease and ulcerative colitis starting anti-TNF therapy over a 2-year period. Medication noncompliance was defined as interruption of medication (not filling anti-TNF prescription if injectable or not getting infliximab infusion for 30 days beyond needed date for continuation) due to patient-driven circumstances. Depressive symptoms were evaluated at baseline using the well-validated Patient Health Questionnaire-9 (PHQ-9), with PHQ-9 ≥ 10 indicative of at least moderate depressive symptoms. Statistical analysis was performed using Cox proportional hazards regression controlling for age, sex, psychiatric history, and disease.

RESULTS:

A total of 246 patients (75 with ulcerative colitis, 171 with Crohn's disease) were started on anti-TNF therapy. Seventy-nine patients (32%) had a prior psychiatric diagnosis reported in the medical record. Thirty-three patients (13%) were noncompliant in follow-up. Sixty patients (24%) had at least moderate depressive symptoms at baseline (PHQ ≥ 10). Depressive symptoms at baseline were significantly associated with noncompliance in follow-up (hazards ratio 2.28, CI 1.1-4.6, p < 0.05).

CONCLUSION:

Depressive symptoms at baseline were associated with medication noncompliance of anti-TNF therapies at follow-up when controlling for age, sex, disease type, and history of psychiatric disease.

• Authors: Alexis Calloway, Robin Dalal, Dawn B Beaulieu, Caroline Duley, Kimberly Annis, Lawrence Gaines, Chris Slaughter, David A Schwartz, Sara Horst
• Journal: Digestive diseases and sciences (Dig Dis Sci) Vol. 62 Issue 12 Pg. 3563-3567 (12 2017) ISSN: 1573-2568 [Electronic] United States
• PMID: 29052816 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Tumor Necrosis Factor-alpha

Topics

• Adult
• Aged
• Antibodies, Monoclonal (pharmacology, therapeutic use)
• Depression (complications)
• Female
• Humans
• Inflammatory Bowel Diseases (drug therapy, psychology)
• Male
• Medication Adherence (psychology)
• Middle Aged
• Retrospective Studies
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)
• Young Adult