POS0433 THE ASSOCIATION BETWEEN DEPRESSION AND BIOLOGIC PRESCRIBING IN AXIAL SPONDYLOARTHRITIS (axSpA): LESSONS FROM AN IRISH axSpA COHORT
Authors: C. Mac Gearailt, F. O’shea, G. Fitzgerald
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Depression is a common comorbidity in axial spondyloarthritis (axSpA). Traditionally depression has been associated with more refractory disease, with concerns raised that patients are potentially overtreated with biologic therapy. Patterns of biologic and conventional synthetic disease-modifying anti rheumatic drugs (csDMARDS) prescribing in those with axSpA and depression are unknown. <h3>Objectives:</h3> To examine the association between depression and use of biologics in a large cohort of Irish axSpA patients. <h3>Methods:</h3> Patients with axSpA were identified from the Ankylosing Spondylitis Registry of Ireland (ASRI) database. ASRI was formed in 2013 in order to provide descriptive epidemiological data on an Irish axSpA cohort. Patient reported data, including comorbidities and medication history, was achieved via structured interviews. Analysis was performed using IBM SPSS version 29. Validated outcome measures were collected: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Health Assessment Questionnaire (HAQ) and Bath Ankylosing Spondylitis Metrology Index (BASMI). <h3>Results:</h3> At the time of analysis, 917 patients were enrolled in the registry (see Table 1): 71.9% (n=659) male, average age 45.9 (SD 12.6) years, predominantly Caucasian (n=819, 96.5%). In ASRI, 68.5% (n=628) of participants had exposure ever to biologic therapies, with 62.7% (n=575) currently using biologic therapies. Of note, 10.7% (n=93) of participants had a diagnosis of depression. Patients with comorbid depression were more likely to have peripheral manifestations of axSpA compared to their peers without depression: peripheral arthritis was more common in those with depression (42.9%) vs 29.6% without depression (p&lt;0.01); 27.5% of patient with depression had enthesitis vs 16.8% of those without depression (p&lt;0.01); psoriasis was present in 25.3% of cases with depression vs 15.7% of those without depression (P&lt;0.02). There was no association between dactylitis, uveitis or colitis and depression. Those with depression had a significantly longer disease duration than those with no history of depression (22.2 years vs 19.1 years, p=0.03). Unemployment status differed significantly (p&lt;0.01) between those with (28.7%) and without depression (16.6%). There was no difference (p&lt;0.05) in those fulfilling modified New York criteria between the two groups. Of those with a diagnosis of depression, 58.5% (n=55) had ever used a biologic, which was significantly lower than biologic use in those without a diagnosis of depression (69.5%, p=0.03). Current biologic use was also significantly lower in those with depression compared to those without (48.9% versus 64.4%, p&lt;0.01). There was no statistical difference in csDMARDS use, with 22.3% of those with depression on csDMARDS compared to 18.9% without depression (p=0.42). Active disease, defined as BASDAI&gt;4, was similar in the groups with and without depression (48.9% vs 47.6%, p=0.81). There was no significant difference in BASDAI, HAQ, BASFI or BASMI between the two groups. <h3>Conclusion:</h3> Patients with a diagnosis of depression in an ASRI cohort were more likely to have peripheral arthritis, psoriasis and enthesitis. Disease severity was similar between those with and without depression in our study, yet those with depression were less likely to have required treatment with biologics than those without depression. Longitudinal studies are required to further investigate this interesting finding. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>