Improvements in patient-reported outcomes, symptoms of depression and anxiety, and their association with clinical remission among patients with moderate-to-severe active early rheumatoid arthritis
Kekow J et al. – Among moderate-to-severe active early RA patients, clinical remission reduces symptoms of depression/anxiety, and independently improves PROs, thereby suppressing the negative impact of depression/anxiety on these measures.
Patients from COmbination of Methotrexate and ETanercept in Active Early Rheumatoid Arthritis (COMET) trial (104 weeks) with measures on Hospital Anxiety and Depression Scale at baseline and subsequent visits (n=389) included
PROs investigated HAQ disability index, pain and fatigue visual analogue scales (VASs), EuroQoL health status VAS and Medical Outcomes Short Form-36 physical and mental component summaries
Impact of clinical remission as measured by 28-joint DAS (DAS-28) on depression/anxiety symptoms at Week 104 assessed using logistic regression
Least square means for PRO improvements from baseline estimated by analysis of covariance
Missing data imputed using last observation carried forward method
When depression/anxiety symptoms were absent at baseline, significantly more patients achieved clinical remission, low disease activity and normal functioning at Week 104
Reciprocally, patients who achieved clinical remission less likely to maintain symptoms of depression or anxiety compared with non-remitters [depression OR: 0.35, P=0.0233; anxiety OR: 0.48, P=0.0371]
Fatigue and pain had significant impact on changes in depression status, but did not influence anxiety status
Clinical remission was significantly associated with improvements in all PRO measures (P<0.001); conversely, depression/anxiety symptoms reduced PRO improvements
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