Cross Raymond K, Sauk Jenny S, Zhuo Joe, Harrison Ryan W, Kerti Samantha J, Emeanuru Kelechi, O'Brien Jacqueline, Ahmad Harris A, Sreih Antoine G, Nguyen Joehl, Horst Sara N, Hudesman David
Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
UCLA Vatche & Tamar Manoukian Division of Digestive Diseases, Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California.
Gastro Hep Adv. 2022 Jul 19;1(6):927-935. doi: 10.1016/j.gastha.2022.07.003. eCollection 2022.
This study aimed to evaluate associations between disease severity, patient-reported outcomes (PROs), and work productivity in patients with inflammatory bowel disease (IBD [Crohn's disease (CD) and ulcerative colitis (UC)]).
Patients diagnosed with CD or UC enrolled in CorEvitas' IBD Registry (May 2017 to September 2019) were included (N = 1543; CD, n = 812; UC, n = 731). Disease severity was assessed using the Harvey-Bradshaw Index (CD) and partial Mayo Score (UC); psychosocial PROs (Patient-Reported Outcomes Measurement Information System [PROMIS]) and work productivity (Work Productivity and Activity Impairment [WPAI]) were assessed. Univariable and multivariable regression analyses assessed associations between PROs and disease severity.
Among CD patients, 67.4% were in remission, 19.2% had mild disease, and 13.4% had moderate/severe disease; among UC patients, 52.7% were in remission, 35.3% had mild disease, and 12.0% had moderate/severe disease. For CD patients in remission, unadjusted percentages of patients with PROMIS scores outside normal limits ranged from 18.9% (depression) to 34.9% (fatigue). For CD patients in remission, 54.3% reported work productivity loss, and 57.1% reported activity impairment. The unadjusted percentage of UC patients in remission with scores outside normal limits ranged from 15.7% (depression) to 28.7% (fatigue) for PROMIS and 10.5% (absenteeism) to 43.5% (activity impairment) for WPAI. Impairment increased with IBD severity. Congruently, adjusted estimates showed significant impairment in PROMIS and WPAI scores for CD and UC patients in remission.
In this real-world analysis, IBD patients across the spectrum of activity, from remission to severe disease, experienced impaired psychosocial function and reduced work productivity. Impairment, even among patients in remission, indicates an unmet need in this patient population.
本研究旨在评估炎症性肠病（IBD，包括克罗恩病（CD）和溃疡性结肠炎（UC））患者的疾病严重程度、患者报告结局（PROs）与工作效率之间的关联。
纳入2017年5月至2019年9月在CorEvitas的IBD注册中心登记的诊断为CD或UC的患者（N = 1543；CD，n = 812；UC，n = 731）。使用哈维-布拉德肖指数（CD）和部分梅奥评分（UC）评估疾病严重程度；评估心理社会PROs（患者报告结局测量信息系统[PROMIS]）和工作效率（工作效率和活动受损[WPAI]）。单变量和多变量回归分析评估PROs与疾病严重程度之间的关联。
在CD患者中，67.4%处于缓解期，19.2%患有轻度疾病，13.4%患有中度/重度疾病；在UC患者中，52.7%处于缓解期，35.3%患有轻度疾病，12.0%患有中度/重度疾病。对于缓解期的CD患者，PROMIS评分超出正常范围的患者未经调整的百分比从18.9%（抑郁）到34.9%（疲劳）不等。对于缓解期的CD患者，54.3%报告工作效率下降，57.1%报告活动受损。缓解期UC患者PROMIS评分超出正常范围的未经调整百分比从15.7%（抑郁）到28.7%（疲劳）不等，WPAI从10.5%（旷工）到43.5%（活动受损）不等。受损程度随IBD严重程度增加。同样，调整后的估计显示缓解期的CD和UC患者在PROMIS和WPAI评分方面存在显著受损。
在这项真实世界分析中，从缓解期到重度疾病的整个活动范围内的IBD患者均经历了心理社会功能受损和工作效率降低。即使在缓解期患者中，这种受损也表明该患者群体存在未满足的需求。
