OBJECTIVES: Depression and anxiety are associated with more severe disease in cross-sectional studies of axial spondyloarthritis (axSpA). We examined the association between baseline symptoms of depression or anxiety and response to TNF inhibitors (TNFi) in axSpA.
METHODS: Biologic naïve participants from a national axSpA register completed the Hospital Anxiety and Depression Scale (HADS) before initiating TNFi. Symptoms of anxiety and depression were each categorised as moderate-severe (≥11), mild (8-10), and 'none' (≤7), and compared against: change in disease indices (BASDAI and ASDAS) over time and time to treatment discontinuation using marginal structural models. Inverse-probability weights balanced baseline age, gender, BMI, deprivation, education, and baseline values of respective indices.
RESULTS: Of the 742 participants (67% male, mean age 45 years), 156 (23%) had moderate-severe and 26% mild depression; 256 (39%) had moderate-severe and 23% mild anxiety. Baseline disease activity was higher in higher HADS symptom categories for both depression and anxiety. Participants with moderate-severe depression had significantly poorer response compared with those with 'none' throughout follow-up. At 6 months, the difference was ∼2.2 BASDAI and 0.8 ASDAS units after balancing their baseline values. Equivalent comparisons for anxiety were 1.7 BASDAI and 0.7 ASDAS units. Treatment discontinuation was HR1.59 higher (95%CI 1.12, 2.26) in participants with moderate-severe anxiety compared with 'none'.
CONCLUSIONS: Symptoms of depression and anxiety at TNFi initiation are associated with significantly poorer treatment outcomes. Targeted interventions to optimise mental health have potential to substantially improve treatment response and persistence.
- axial spondyloarthritis
- mental health
- treatment response