Depressive Symptoms Predict Anti-tumor Necrosis Factor Therapy Noncompliance in Patients with Inflammatory Bowel Disease

• Published in: Digestive diseases and sciences 2017-12, Vol.62 (12), p.3563-3567
• Main Authors: Calloway, Alexis, Dalal, Robin, Beaulieu, Dawn B., Duley, Caroline, Annis, Kimberly, Gaines, Lawrence, Slaughter, Chris, Schwartz, David A., Horst, Sara
• Format: Article
• Language: English
• Subjects: Adalimumab; Adult; Aged; Analysis; Antibodies, Monoclonal - pharmacology; Antibodies, Monoclonal - therapeutic use; Biochemistry; Colon; Crohn's disease; Depression - complications; Depression, Mental; Female; Gastroenterology; Hepatology; Humans; Inflammatory bowel disease; Inflammatory Bowel Diseases - drug therapy; Inflammatory Bowel Diseases - psychology; Male; Medication Adherence - psychology; Medicine; Medicine & Public Health; Middle Aged; Monoclonal antibodies; Necrosis; Oncology; Original Article; Patient compliance; Patients; Retrospective Studies; Transplant Surgery; Tumor necrosis factor; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor necrosis factor-TNF; Tumors; Ulcerative colitis; Young Adult
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-017-4800-y

Background Noncompliance in use of anti-tumor necrosis factor (anti-TNF) therapy in patients with moderate-to-severe inflammatory bowel disease (IBD) can be a factor in medication failure. Few studies have evaluated the contribution of depressive symptoms to medication noncompliance in anti-TNF therapies. Methods A retrospective chart review was performed in a single-center tertiary care IBD center for patients with Crohn’s disease and ulcerative colitis starting anti-TNF therapy over a 2-year period. Medication noncompliance was defined as interruption of medication (not filling anti-TNF prescription if injectable or not getting infliximab infusion for 30 days beyond needed date for continuation) due to patient-driven circumstances. Depressive symptoms were evaluated at baseline using the well-validated Patient Health Questionnaire-9 (PHQ-9), with PHQ-9 ≥ 10 indicative of at least moderate depressive symptoms. Statistical analysis was performed using Cox proportional hazards regression controlling for age, sex, psychiatric history, and disease. Results A total of 246 patients (75 with ulcerative colitis, 171 with Crohn’s disease) were started on anti-TNF therapy. Seventy-nine patients (32%) had a prior psychiatric diagnosis reported in the medical record. Thirty-three patients (13%) were noncompliant in follow-up. Sixty patients (24%) had at least moderate depressive symptoms at baseline (PHQ ≥ 10). Depressive symptoms at baseline were significantly associated with noncompliance in follow-up (hazards ratio 2.28, CI 1.1–4.6, p