THU0164 Efficacy of biologic dmards in depressive symptoms in patients with rheumatoid arthritis
Authors: K.J. Ng, K.-Y. Huang, C.-H. Tung, M.-C. Lu, N.-S. Lai
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Rheumatoid arthritis (RA) affects people both physically and psychologically. Comorbid depression is common, with a prevalence of 13%–42%.<sup>1</sup> According to 2015 ACR Guideline, RA patients should be treated with conventional synthetic or biologic Disease Modifying Anti-Rheumatic Drugs (csDMARDs or bDMARDs) according to their disease activity.<sup>2</sup> Correlating depression with RA disease activity, it is thought that patients with lower disease activity are less likely to be depressed(.<sup>1</sup> A study comprising 83 RA patients revealed lower frequency of depressive disorders in anti-TNF group regardless of disease activity, however the data is limted by small case number.(<sup>3</sup> A review of inflammation in depression in 2016 reported IL-1β, IL-6, TNF and CRP as the most reliable biomarkers of inflammation in depression.<sup>4</sup> Thus, chronic inflammatory status in RA might contribute to a high risk of depression. <h3>Objectives</h3> This aim of this study was to investigate the independent effect of the use of bDMARDs on the risk of depression in RA patients. <h3>Methods</h3> Using a cross-sectional study design, patients with definitive diagnosis of RA were recruited during regular outpatient follow-up in a regional hospital in southern Taiwan. Data was ascertained by questionnaires, laboratory measurements, and medical records. RA disease activity and depressive symptoms were recorded with the Disease Activity Score 28 (DAS 28) and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), respectively. Patients were considered to be depressive cases if their HADS-D score &gt;11. Patients who were prescribed with csDMARDs were considered as the non-biologic group, and those who were under bDMARDs or combination of csDMARDs and bDMARDs were considered as the biologic group. <h3>Results</h3> A total of 378 RA patients were recruited with 60 patients in the non-biologic group and 318 patients in the biologic group. Baseline characteristics including sex, educational level, marital status, socioeconomic status, working status, vegetarian dietary habit, and religion were similar between two groups. 4.1% of the biologic patients and 13.3% of the non-biologic patients were classified as depressive. Results from the multiple logistic regression analysis adjusted for the possible confounders including disease activity showed that biologic treatment was significantly associated a lower risk of depression (odds ratio=10.11, 95% CI=2.72–37.64, p=0.001). <h3>Conclusions</h3> Patients receiving bDMARDs showed a significant lower risk of depression, despite their higher RA disease activity. Further studies on the association between the use of bDMARDs and risk of depression are warranted. <h3>References</h3> [1] Margaretten M, Julian L, Katz P, et al. Depression in patients with rheumatoid arthritis: description, causes and mechanisms. Int J Clin Rheumtol2011;6:617–23. [2] Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol2016;68:1–26. [3] Uguz F, Akman C, Kucuksarac S, Tufekci O. Anti-tumor necrosis factor-alpha therapy is associated with less frequent mood and anxiety disorders in patients with rheumatoid arthritis. Psychiatry Clin Neurosci2009;63(1):50–5. [4] Miller AH, Raison CL. The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nat Rev Immunol2016;16:22–34. <h3>Disclosure of Interest</h3> None declared