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Background: Comorbid depression in patients with axial spondyloarthritis (axSpA) is suspected to negatively affect the disease course and outcomes including clinical remission, but the evidence is still sparse. Objectives: This analysis investigates the influence of depressive symptoms at the start of a new systemic therapy on disease activity and remission (ASDAS low disease activity LDA and ASDAS inactive disease ID) at 6 months in a real-word cohort of axSpA patients. Methods: We included all patients from the RABBIT-SpA cohort with an axSpA diagnosis with a WHO-5 Well-Being Index score (WHO-5) at baseline and 6-month follow-up (complete case analysis). We performed a descriptive analysis of baseline characteristics and disease activity parameters over 6 months and determined the proportion of patients reaching LDA or ID by category of depressive symptoms. Moderate or severe depressive symptoms were defined as a WHO-5 score below 29 (out of 100). Using a directed acyclic graph (DAG), we derived an adjustment set of baseline variables consisting of ASDAS-CRP, age, arthritic joint count, BMI, comorbidity count, tender enthesitis points count, HLA-B27 status, sex, sports, symptom duration, and type of antirheumatic therapy, and performed a logistic regression to determine the effect of depressive symptoms on the chance of achieving LDA and ID. Results: Out of the 1,276 axSpA patients with a WHO-5 at baseline, 1,168 (91.5%) had a 6 month follow-up and were included in the analysis. Patients with moderate or severe depressive symptoms had worse values across all disease activity parameters at baseline (Table 1), compared with those with no or mild symptoms. At 6 months, 67% of patients with no or mild depressive symptoms reached LDA and 34% ID. In patients with moderate or severe depressive symptoms, it was 46% and 18%, respectively (Figure 1). AxSpA patients who had no or mild depression were significantly more likely to reach LDA at 6-months follow-up compared to patients with moderate or severe depression (OR = 1.17, 95% CI = 1.08-1.28, p p = 0.02). Conclusion: Patients with moderate or severe depressive symptoms had worse values across all parameters of disease activity and reached remission or low disease activity less often than patients with mild or no depressive symptoms. Depressive symptoms had an independent influence on patients' chance to achieve remission. Screening for depression is an important step that should be undertaken by clinicians as it can affect likelihood of later disease activity and remission. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: Andreas Reich None personal; RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Celltrion, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris., Anja Weiß None personal; RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Celltrion, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris., Hanns-Martin Lorenz: None declared, Georg Dahmen: None declared, Lisa Lindner None personal; RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Celltrion, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris., Anja Strangfeld Speaker fees AbbVie, Biogen, Galapagos, Janssen, Lilly, Pfizer, Takeda., None personal, joint and unconditional grant for the RABBIT project from AbbVie, Amgen, Biocon, Bristol Myers Squibb, Celltrion, Fresenius Kabi, Galapagos, Hexal, Lilly, MSD, Pfizer, Samsung Bioepis, Sanofi Aventis, and UCB., Denis Poddubnyy: None declared, Xenofon Baraliakos: None declared, Anne Regierer Speaker fees Amgen, BMS, Novartis, Pfizer, Roche., None personal; RABBIT-SpA is supported by a joint, unconditional grant from AbbVie, Amgen, Biogen, Celltrion, Hexal, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, UCB and Viatris.
Reich et al. (Sat,) studied this question.