Deb Arijita, Dwibedi Nilanjana, LeMasters Traci, Hornsby Jo Ann, Wei Wenhui, Sambamoorthi Usha
Associate Director, Outcomes Research, Merck, and was a PhD candidate during this study.
Assistant Professor.
Am Health Drug Benefits. 2019 Feb;12(1):30-38.
Individuals with rheumatoid arthritis (RA) are at high risk for depression because of the overall burden of systemic inflammation. Although some evidence suggests that treatment with powerful anti-inflammatory drugs, such as tumor necrosis factor (TNF) inhibitors, may be effective in reducing the risk for depression in patients with RA, it is unclear whether such reduction in risk is dependent on the response to TNF inhibitor therapy.
To evaluate the association between the response to TNF inhibitor therapy and the risk for depression among working-age adults with RA.
This retrospective, observational cohort study design was based on data derived from commercial claims data in the QuintilesIMS Real World Data Adjudicated Claims database between October 1, 2009, and September 30, 2015. A total of 4222 working-age adults (18-62 years) with RA who started treatment with TNF inhibitor therapy and were continuously enrolled during the 3 observation periods (ie, 1-year baseline, 1-year treatment, and 1-year follow-up periods) were included in the study. Treatment response to a TNF inhibitor was measured using prescription drug claims based on a published validated algorithm. Multivariable logistic regression was used to examine the association between treatment response to TNF inhibitor therapy and the risk for depression, after controlling for baseline demographic characteristics, clinical characteristics, and RA-related medication use. An inverse probability of treatment weighting technique was used to control for observable differences in TNF inhibitor responders' characteristics versus TNF inhibitor nonresponders.
Overall, 359 (8.5%) patients with RA had depression during the follow-up period and 1679 (39.8%) patients responded to TNF inhibitor treatment during the 1-year treatment period. A significantly lower percentage of TNF inhibitor responders (7.1%, N = 119) had depression than TNF inhibitor nonresponders (9.4%, N = 239). After controlling for other risk factors, responders to TNF inhibitors were 20% less likely to have depression during the follow-up period (adjusted odds ratio, 0.80; 95% confidence interval, 0.64-0.98) than nonresponders to TNF inhibitor therapy.
The risk for depression was significantly reduced among patients with RA who responded to TNF inhibitor therapy compared with those who did not respond to such therapy. To determine whether the lower rate of depression observed with TNF inhibition is a direct effect of treatment with a TNF inhibitor, or whether it could be attributed to improvement in RA disease secondary to treatment, future studies need to also incorporate a control population of patients with RA who receive other antirheumatic regimens, such as disease-modifying antirheumatic drugs.
由于全身性炎症的总体负担，类风湿关节炎（RA）患者患抑郁症的风险较高。尽管一些证据表明，使用强效抗炎药物（如肿瘤坏死因子（TNF）抑制剂）进行治疗可能有效降低RA患者患抑郁症的风险，但尚不清楚这种风险降低是否依赖于对TNF抑制剂治疗的反应。
评估工作年龄的RA成年人对TNF抑制剂治疗的反应与患抑郁症风险之间的关联。
这项回顾性观察性队列研究设计基于2009年10月1日至2015年9月30日期间QuintilesIMS真实世界数据裁决索赔数据库中的商业索赔数据。共有4222名工作年龄（18 - 62岁）开始使用TNF抑制剂治疗并在3个观察期（即1年基线期、1年治疗期和1年随访期）持续入组的RA成年人纳入研究。根据已发表的经过验证的算法，使用处方药索赔来衡量对TNF抑制剂的治疗反应。在控制基线人口统计学特征、临床特征和RA相关药物使用后，使用多变量逻辑回归来检验对TNF抑制剂治疗的反应与患抑郁症风险之间的关联。采用治疗加权的逆概率技术来控制TNF抑制剂反应者与非反应者特征的可观察差异。
总体而言，359名（8.5%）RA患者在随访期间患有抑郁症，1679名（39.8%）患者在1年治疗期内对TNF抑制剂治疗有反应。TNF抑制剂反应者患抑郁症的比例（7.1%，N = 119）显著低于非反应者（9.4%，N = 239）。在控制其他风险因素后，与TNF抑制剂治疗的非反应者相比，反应者在随访期间患抑郁症的可能性降低20%（调整后的优势比为0.80；95%置信区间为0.64 - 0.98）。
与未对TNF抑制剂治疗产生反应的患者相比，对TNF抑制剂治疗有反应的RA患者患抑郁症的风险显著降低。为了确定观察到的TNF抑制导致抑郁症发生率较低是TNF抑制剂治疗的直接效果，还是可归因于治疗后RA疾病的改善，未来的研究还需要纳入接受其他抗风湿治疗方案（如改善病情抗风湿药物）的RA患者对照人群。
