Effects of anti-TNF therapy and immunomodulators on anxiety and depressive symptoms in patients with inflammatory bowel disease: a 5-year analysis
Alexander Siebenhüner, Jean‐Benoît Rossel, Philipp Schreiner, Matthias Butter, Thomas Greuter, Niklas Krupka, Sebastian Bruno Ulrich Jordi, Luc Biedermann, Gerhard Rogler, Benjamin Misselwitz, Roland von Känel, Karim Abdelrahman, Gentiana Ademi, Patrick Aepli, Amman Thomas, Claudia Anderegg, Anca-Teodora Antonino, Eva Archanioti, Eviano Arrigoni, Nurullah Aslan, Diana Bakker de Jong, Bruno M. Balsiger, Mamadou-Pathé Barry, Polat Bastürk, Peter Bauerfeind, Andrea Becocci, José M. Bengoa, Luc Biedermann, Janek Binek, Mirjam Blattmann, Stephan Boehm, Tujana Boldanova, Jan Borovicka, Christian Braegger, Stephan Brand, Francisco Bravo, Lukas Brügger, Simon Brunner, Patrick Bühr, Sabine Burk, Emanuel Burri, Matthias Butter, Sophie Buyse, Dahlia-Thao Cao, Ove Carstens, Dominique Criblez, Fabrizia D’Angelo, Philippe de Saussure, Lukas Degen, Joakim Delarive, Christopher Doerig, Barbara Dora, Susan Drerup, C Ducrey, Ali El-Wafa, Matthias Engelmann, Aude Erdmann-Voisin, Christian Felley, Markus Fliegner, Montserrat Fraga, Yannick Franc, Pascal Frei, Remus Frei, Michael Fried, Florian Froehlich, Raoul I. Furlano, Luca Garzoni, Martin Geyer, Marc Girardin, Delphine Golay, Ignaz Good, Ulrike Graf Bigler, Sébastien Godat, Thomas Greuter, Beat Gysi, Johannes Haarer, Marcel Halama, Janine Haldemann, Pius Heer, Benjamin Heimgartner, Beat Helbling, Peter Hengstler, Denise Herzog, Cyrill Hess, Roxane Hessler, Klaas Heyland, Thomas Hinterleitner, Claudia Hirschi, Petr Hrúz, Pascal Juillerat, Ioannis Kapoglou, Stephan Kayser, Céline Keller, Carolina Khalid-de Bakker, Christina Knellwolf, Christoph Knoblauch, Henrik Köhler, Rebekka Koller, Claudia Krieger, Patrizia Künzler‐Heule
Abstract
BACKGROUND AND AIMS: Anxiety and depression are prevalent in patients with inflammatory bowel diseases (IBD), especially during IBD flares. IBD therapies can profoundly affect the mood of patients with IBD. We aimed to determine the long-term impact of anti-tumor necrosis factor (anti-TNF) and immunomodulators (IM) on anxiety and depressive symptoms in IBD patients. METHODS: We compared three treatment groups with IM only (group A), anti-TNF ± IM (group B) and no such therapy (group C). Patients completed the hospital anxiety and depression scale (HADS) at 1 year, 3 years, and 5 years after start of treatment. RESULTS: In total, 581 patients with IBD (42.9% Crohn's disease, 57.1% ulcerative colitis/IBD unclassified) participated in this study. Effects of treatment were analyzed in a mixed effects model, with and without correction for confounders. Compared with group C, group B showed a significant treatment-related improvement in both anxiety and depressive symptoms within the first 2.5 years and also thereafter. Group A showed a significant long-term improvement of anxiety and both short-term and long-term improvement in depressive symptoms. The significance of these results was maintained after correction for confounders, including corticosteroid treatment. Additionally, both groups A and B showed a significant decrease in disease activity in the first 2.5 years after start of treatment and also thereafter. Anti-TNF and IM treatment were associated with a similarly significant decrease in anxiety and depressive symptoms over an observation period of up to 5 years. CONCLUSION: Besides a clear benefit for disease activity, anti-TNF and IM apparently improve the mood of patients with IBD.