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Background: Anxiety and depression are comorbidities among PsA patients. The impact of anxiety and depression on outcomes in PsA patients has not been characterized in a real-world clinical setting.
Objectives: To describe the prevalence of anxiety and/or depression in PsA patients, assess concordance in reported anxiety and/or depression between patients and physicians, and compare clinical and patient reported outcomes (PROs) in patients who do and do not report anxiety and/or depression.
Methods: A cross-sectional study of patients with PsA recruited by rheumatologists and dermatologists was conducted in France, Germany, Italy, Spain, UK and US. Data were collected Jun-Aug 2018 via physician-completed and patient self-completed forms. Physicians reported patient demographic, disease characteristics and diagnosed anxiety and/or depression. Patients reported experience of PsA-related anxiety/depression, quality of life [QoL] (EQ5D-5L), work productivity (WPAI), disability (HAQ-DI), and disease impact (PsAID12). Patients were compared according to patient reported anxiety/depression using parametric and non-parametric tests. Multivariate regressions explored impact of anxiety/depression on PROs. Models adjusted for age, gender, employment status, BMI, # of joints affected, body surface area (BSA).
Results: Data were collected from 688 physician-patient pairs (524 EU; 164 US). Physicians reported anxiety and/or depression in 14.2% of patients (EU 13.3%; US 16.2%), while 36.6% (EU 36.3%; US 37.8%) of patients self-reported anxiety and/or depression. 71.4% of physician-patient pairs agreed on anxiety and/or depression presence or absence (Kappa = 0.31, fair agreement). Patients with anxiety and/or depression had worse QoL more work impairment, greater disability (Table 2).
Demographic and clinical characteristics by patient-reported anxiety and/or depression
| No anxiety and/or depression
| Anxiety and/or depression
| P value | |
|---|---|---|---|
| Demographics | |||
| Age, mean (SD) | 47.7 (12.1) | 49.1 (12.6) | 0.13 |
| Female, n (%) | 196 (45.0) | 146 (57.9) | <0.01 |
| BMI, mean (SD) | 26.7 (5.1) | 26.9 (4.4) | 0.57 |
| Caucasian, n (%) | 408 (93.3) | 238 (94.4) | 0.46 |
| Working full time, n (%) | 293 (68.6) | 107 (44.8) | <0.01 |
| Biologic tx, n (%) | 257 (58.9) | 160 (63.5) | 0.26 |
| Disease characteristics | |||
| Days since diagnosis, mean (SD) | 2090 (2204) | 2532 (2813) | 0.04 |
| Current overall severity, n (%) | |||
| Mild | 277 (63.5) | 137 (54.4) | 0.02 |
| Moderate | 145 (33.3) | 106 (42.1) | |
| Severe | 14 (3.2) | 9 (3.6) | |
| Current BSA %, mean (SD) | 8.7 (12.3) | 6.4 (8.2) | 0.02 |
| 66 swollen joint count, mean (SD) | 2.7 (3.6) | 5.6 (10.4) | <0.01 |
| 68 tender joint count, mean (SD) | 3.8 (4.3) | 6.0 (6.2) | <0.01 |
Impact of anxiety or depression on PROs*
| Anxiety and/or depression | Change in predicted PRO value with anxiety and/or depression α | P value | |
|---|---|---|---|
| EQ5D utility score, mean N=488 | Without (ref)
| 0.83
| <0.01 |
| WPAI percentage overall work impairment, mean N=262 | Without
| 22.3
| <0.01 |
| HAQ-DI score, mean
| Without
| 0.53
| <0.01 |
| PsAID12 score, mean
| Without
| 2.32
| <0.01 |
* Adjusted for age, gender, employment status, BMI, # of joints affected and BSA
α PRO key for worse outcome (range): EQ5D utility (0-1.0) = lower; EQ5D VAS (1-100) = lower; WPAI (0-100) = higher; HAQ-DI (0-3) = higher; PsAID12 (0-10) = higher.
Conclusion: One third of patients self-report anxiety and/or depression. Treating physicians may not be aware of patient experience of anxiety and/or depression. Patients with anxiety and/or depression appear to have worse QoL, work productivity and disability outcomes than those without.
Disclosure of Interests: Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, Jessica A. Walsh Grant/research support from: AbbVie, Pfizer, Janssen, Consultant of: AbbVie, Novartis, Eli Lilly and Company, UCB, Kaleb Michaud Grant/research support from: Janssen, Elizabeth Holdsworth Employee of: Adelphi Real World, Steve Peterson Employee of: Janssen Research & Development, LLC, Sophie Meakin Employee of: Adelphi Real World, Sara Bruce Wirta Employee of: Janssen-Cilag Sweden AB, Soumya D Chakravarty Shareholder of: Johnson & Johnson, Employee of: Janssen Scientific Affairs, LLC, Alexis Ogdie Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB, Consultant of: Abbvie, Amgen, Bristol-Myers Squibb, Celgene, Corrona, Janssen, Eli Lilly, Novartis, Pfizer