Discontinuation of Anti-TNF Agents More Likely in Patients With IBD Plus Anxiety, Mood Disorders

A team of investigators assessed the impact of anxiety and mood disorders on treatment with anti-tumor necrosis factor agents in individuals with inflammatory bowel disease.

Patients with irritable bowel disorder (IBD) are at increased risk for anxiety and mood disorders (AMDs), and those patients with IBD who experience an AMD within a 2-year period prior to the start of tumor necrosis factor antagonist (anti-TNF) agents are more likely to discontinue therapy compared with patients without an AMD. These findings were reported in a study published in Clinical Gastroenterology and Hepatology.

The study included patients with IBD from the Canadian province of Manitoba who were enrolled in the University of Manitoba IBD Epidemiology Database. Only patients with IBD who were prescribed a TNF inhibitor from 2001 through 2016 (n=1135) as well as patients who fulfilled a criterion for AMD in the 2 years prior to the start of treatment with an anti-TNF agent (n=178) were identified and included in the analysis. The only agents used in this cohort were infliximab and adalimumab.

The investigators assessed the association between active AMD with discontinuation of a TNF inhibitor and the first occurrence of an adverse outcome related to IBD. Adverse outcomes associated with IBD were defined as either IBD-related hospitalization or surgery, new or recurrent corticosteroid use, changing to a different anti-TNF agent, or death. All outcomes were compared between patients who did and did not experience an AMD in the 2 years before starting an anti-TNF agent.

The adjusted Cox regression model revealed AMD to be a significant predictor of anti-TNF discontinuation (adjusted hazard ratio [HR], 1.28; 95% CI, 1.03-1.59). A significantly higher proportion of patients with AMD discontinued anti-TNF therapy within the first year compared with those without a history of AMD (44% vs 34%, respectively; P =.008). In the multivariable model, the occurrence of AMDs was associated with discontinuation of a TNF inhibitor in the year following the initiation of treatment with the anti-TNF agent (HR, 1.50; 95% CI, 1.15-1.94). In the overall analysis, no significant association was seen between AMD and the development of any IBD-related adverse outcome during anti-TNF therapy (HR, 0.94; 95% CI, 0.69-1.28).

Limitations of this study include reliance on database data rather than direct patient evaluations, lack of information on AMD severity, and lack of information on the reasons behind discontinuation of anti-TNF agents.

In light of these limitations, the researchers suggest additional studies may be helpful to examine “the benefits of targeted screening and interventions for AMDs in persons with IBD about to start an anti TNF, in particular in clinical settings where successful treatment would be highly impactful.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Dolovich C, Bernstein CN, Singh H, et al. Anxiety and depression leads to anti-tumor necrosis factor discontinuation in inflammatory bowel disease [published online July 12, 2020. Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2020.07.013