abstract details

The summaries are free for public use. ARTHROS will continue to add and archive summaries of articles deemed relevant to ARTHROS by our Faculty.

Infliximab treatment reduces depressive symptoms in patients with ankylosing spondylitis: an ancillary study to a randomized controlled trial (ASSERT)

Author

Arthritis Res Ther. 2020 Sep 29;22(1):225. doi: 10.1186/s13075-020-02305-w.

Casper Webers 1 2Carmen Stolwijk 3Olga Schiepers 4Thea Schoonbrood 5Astrid van Tubergen 5 6Robert Landewé 7 8Désirée van der Heijde 9Annelies Boonen 5 6

Author Information

1 Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands. casper.webers@mumc.nl.

2 Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands. casper.webers@mumc.nl.

3 Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands.

4 Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.

5 Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, The Netherlands.

6 Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.

7 Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Centre, University of Amsterdam, Amsterdam, the Netherlands.

8 Department of Rheumatology, Zuyderland Medical Centre, Heerlen, the Netherlands.

9 Department of Rheumatology, Leiden University Medical Centre, Leiden, the Netherlands.

Abstract

Background: Patients with ankylosing spondylitis (AS) are at increased risk of depression. This increased risk has been hypothesized to be solely secondary due to AS-related symptoms, or additionally due to a common inflammatory pathway. From a clinical perspective, it is important to know whether treatment with tumor necrosis factor alpha inhibitors reduces depressive symptoms, while from a pathophysiological point of view, it would be insightful to understand whether such an effect would be a direct result of reduced inflammation, the result of reduced AS-related symptoms, or both. The objective of this study was to evaluate the effect of infliximab on depressive symptoms in patients with AS in a randomized-controlled trial setting.

Methods: Data were retrieved from a subgroup of patients from the AS Study for the Evaluation of Recombinant Infliximab Therapy (ASSERT). Patients were randomly allocated to infliximab (n = 16) or placebo (n = 7) until week 24, after which all received infliximab until week 54. Associations between treatment group and depressive symptoms, measured with the Center for Epidemiological Studies Depression scale (CES-D, range 0-60 (best-worst)) at baseline and over time, were explored with generalized estimating equations (GEE).

Results: Mean CES-D score at baseline was 15.5 (SD 9.3) in the infliximab group and 17.3 (SD 5.7) in the placebo group. Twelve patients (52%) had a CES-D score > 16, suggestive for clinical depression. After 24 weeks, mean CES-D had decreased to 9.5 (SD 11.4) in the infliximab group, but was 18.0 (SD 6.9) in the placebo group. GEE revealed larger improvements in depressive symptoms (B = - 6.63, 95%CI - 13.35 to 0.09) and odds of possible depression (OR = 0.02, 95%CI 0.00 to 0.72) in the infliximab group, compared to the placebo group. Both associations largely disappeared when adjusted for self-reported disease activity and/or physical function. Additional adjustment for C-reactive protein (CRP) did not change results.

Conclusions: Depressive symptoms are common in patients with AS and active disease. Infliximab improves these depressive symptoms in AS when compared to placebo by improving disease symptoms. We did not find an indication for a direct link between CRP-mediated inflammation and depressive symptoms.

Trial registration: Trial registration (ASSERT): NCT00207701 . Registered on September 21, 2005 (retrospectively registered).