Effects of anti-TNF therapy and immunomodulators on anxiety and depressive symptoms in patients with inflammatory bowel disease: a 5-year analysis

Alexander R Siebenhüner; Jean-Benoît Rossel; Philipp Schreiner; Matthias Butter; Thomas Greuter; Niklas Krupka; Sebastian B U Jordi; Luc Biedermann; Gerhard Rogler; Benjamin Misselwitz; Roland von Känel

doi:10.1177/17562848211033763

Effects of anti-TNF therapy and immunomodulators on anxiety and depressive symptoms in patients with inflammatory bowel disease: a 5-year analysis

Therap Adv Gastroenterol. 2021 Aug 31:14:17562848211033763. doi: 10.1177/17562848211033763. eCollection 2021.

Affiliations

¹ Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Rämistrasse 100, Zurich, CH-8091, Switzerland.
² Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Vaud, Switzerland.
³ Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
⁴ Department of Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland.
⁵ Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Switzerland.

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.

Keywords: anti-TNF; anxiety; depressive symptoms; hospital anxiety and depression scale; immune-modulatory therapy; inflammatory bowel disease; mood; psychosocial factors.