THU0145 INDICATIONS AND INCIDENCE OF TREATMENT WITH ANTIDEPRESSANTS IN PATIENTS WITH RHEUMATOID ARTHRITIS AND MATCHED CONTROLS
Authors: J. K. Pedersen, K. Andersen, A. J. Svendsen, K. Hørslev-Petersen
Journal: Annals of the Rheumatic Diseases (2020)

Background: The incidence of depression is about 1.5-2 times higher in patients with rheumatoid arthritis (RA) versus controls. (1, 2) Previous data on treatment with antidepressants has pointed to an almost equal distribution of indications between depression and other indications. (3) Objectives: To describe and compare indications and the incidence of treatment with antidepressants in patients with RA and matched controls. Methods: The study involved an inception cohort of patients with incident RA ascertained from 1995 to 2002 according to the American College of Rheumatology 1987 classification criteria (4) and randomly drawn, population controls with the same age, sex, and area of residence (ratio 1:5). Indications on redeemed prescriptions were included in the Danish National Prescription Register from 2004 and we collected data on all prescriptions for antidepressants (Anatomical Therapeutic Classification code N06A) and counted person-years (PY) at risk from 01.01.2004 to 31.12.2017, death, or migration. The incidence of first treatment was evaluated as defined daily dose (DDD) for two definitions of exposure (DDD&gt;0, DDD&gt;178) within one calendar year together with the positive indication depression after one year of run-in. Results: The current analyses involved 431 RA patients and 2167 controls (median age at inclusion: 59 years, 70% females; RA patients: 20% erosive, 74% rheumatoid factor positive). The most frequent indication for treatment with antidepressants was depression (Table 1). Table 1. Indication on prescriptions for antidepressants, % (95% confidence interval (CI)) Rheumatoid arthritis (n=6,955) Controls (n=33,740) Depressive disorders 62.3 (61.2-63.5) 62.7 (62.2-63.2) Anxiety disorders 5.4 (4.9-6.0) 3.9 (3.7-4.1) Nervous system medications 6.5 (5.9-7.1) 6.8 (6.6-7.1) Other indications 0.2 (0.0-0.3) 0.2 (0.2-0.2) No or missing indications 25.6 (24.6-26.7) 26.3 (25.9-26.8) There were no significant differences in the incidence of treatment with the indication depression in patients versus controls (Table 2 ). Table 2. Incidence rate ratio for treatment with antidepressants DDD&gt;0 DDD&gt;178 Rheumatoid arthritis (Events/PY) Controls (Events/PY) Incidence rate ratio (95% CI) Rheumatoid arthritis (Events/PY) Controls (Events/PY) Incidence rate ratio (95% CI) Overall 98/3,720 471/19,229 1.08 (0.86-1.34) 73/3,893 339/20,338 1.13 (0.87-1.46) Sex Females 79/2,616 354/13,460 1.15 (0.89-1.47) 61/2,753 264/14,299 1.20 (0.89-1.59) Males 19/1,104 117/5,769 0.85 (0.49-1.39) 12/1,141 75/6,039 0.85 (0.42-1.57) Age 15-34 5/175 24/962 1.15 (0.34-3.07) 4/188 21/1,022 1.04 (0.26-3.07) 35-44 3/522 31/2,349 0.44 (0.85-1.40) 3/524 20/2,501 0.72 (0.14-2.42) 45-54 14/731 64/3,871 1.16 (0.60-2.09) 10/773 40/4,122 1.33 (0.59-2.71) 55-64 25/1,198 128/6,200 1.01 (0.63-1.56) 17/1,253 84/6,498 1.05 (0.58-1.78) 65-74 37/849 158/4,598 1.27 (0.86-1.82) 28/892 120/4,874 1.28 (0.81-1.94) 75+ 14/246 66/1,248 1.08 (0.56-1.94) 11/265 54/1,321 1.02 (0.48-1.97) Conclusion: The main indication for prescribing antidepressants in patients with RA was depression. Patients with RA were not exposed to antidepressants more often than controls. This could be due to prescription bias or reflect pertinent choice of treatment in patients with RA. References: [1]Wang SL, et al. PLoS One 2014;9:e107791. [2]Marrie RA, et al. Arthritis Care Res 2018;70:970-8. [3]Wong J, et al. JAMA 2016;315:2230-2. [4]Pedersen JK, et al. Scand J Rheumatol 2018;47:371-7. Acknowledgments: The study was supported by the Danish Rheumatism Association Disclosure of Interests: None declared