Psychosocial Burden Common Among Patients With Inflammatory Bowel Disease

ulcerative colitis
stomachache, ibd, inflammatory bowel disease, ulcerative colitis, crohn disease
Researchers examined work productivity, disease severity, and patient-reported outcomes among individuals with inflammatory bowel disease.

Patients with inflammatory bowel disease (IBD) experience impaired psychosocial function and reduced work productivity, even in remission, according to study findings published in Gastro Hep Advances.

Researchers sourced data from the CorEvitas’ IBD registry, which was launched in May 2017. As of June 2020, 62 clinical sites with 135 gastroenterologists located in 20 states in the United States enrolled their patients in the registry. Patients (N=1543) were evaluated by the Harvey-Bradshaw Index (HBI) or partial Mayo Score (pMS), Patient-Reported Outcomes Measurement Information System (PROMIS), and Work Productivity and Activity Impairment (WPAI) instruments. Psychosocial function and work productivity were related with disease severity.

The Crohn disease (CD; n=812) and ulcerative colitis (UC; n=731) cohorts included 57.5% and 53.7% women; participants had a mean age of 47.1±16.8 and 47.7±16.9 years; 87.2% and 83.2% were White; 65.0% and 65.0% were employed; 76.8% and 76.8% were college educated; 60.6% and 39.8% were receiving biologic or Janus kinase (JAK) inhibitor therapies; 19.3% and 54.2% were receiving 5-aminosalicylate therapy; 17.0% and 11.8% were receiving immunomodulator therapy; and 13.7% and 14.0% were receiving corticosteroids, respectively.

Among the CD cohort, 67.4% were in remission, 19.2% had mild disease, 12.7% moderate disease, and 0.7% severe disease. For the UC cohort, 52.7% were in remission, 35.3% had mild disease, 8.5% moderate disease, and 3.6% severe disease.

Among both cohorts, PROMIS scores increased with disease severity for anxiety, depression, fatigue, pain interference, and sleep disturbance. Similarly, the proportion of patients who worked decreased with disease severity and WPAI domains for absenteeism, presenteeism, work productivity loss, and activity impairment scores increased with severity.

For CD, the proportion of patients who were outside the normal score ranged from 18.9% for depression to 34.9% for fatigue. More than half of patients with CD in remission reported work productivity loss (54.3%) and activity impairment (57.1%).

In UC, the proportion of patients outside the normal limits ranged from 15.7% for depression to 28.7% for fatigue. Nearly half of patients in remission reported activity impairment (43.5%).

In the regression analysis, disease activity effects were only mildly attenuated by adjusting for education and history of surgery.

The analysis was limited by a predominantly White study population with a college education and private insurance; these trends may not be generalizable to the US IBD population.

“Psychosocial impairment and decreased work productivity were seen even in patients in remission, who made up approximately 67% and 53% of patients in the CD and UC cohorts, respectively,” the study authors wrote. “The prevalence of self-reported fatigue, pain, and anxiety and depression remains high among patients with IBD in remission and indicates that there may be important aspects of disease impacting patients’ lives that have not been captured in standard disease activity assessments.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Cross RK, Sauk JS, Zhuo J, et al. Poor Patient-Reported Outcomes and Impaired Work Productivity in Patients With Inflammatory Bowel Disease in Remission. Gastro Hep Advances. Published online July 19, 2022. doi:10.1016/j.gastha.2022.07.003