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Original research
Introduction and switching of biologic agents are associated with antidepressant and anxiolytic medication use: data on 42 815 real-world patients with inflammatory rheumatic disease
  1. Vasiliki-Kalliopi Bournia1,
  2. Maria G Tektonidou1,
  3. Dimitrios Vassilopoulos1,
  4. Katerina Laskari1,
  5. Stylianos Panopoulos1,
  6. Kalliopi Fragiadaki1,
  7. Konstantinos Mathioudakis2,
  8. Anastasios Tsolakidis2,
  9. Panagiota Mitrou3 and
  10. Petros P Sfikakis1
  1. 1Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
  2. 2IDIKA SA - e-Government Center for Social Security Services, Athens, Greece
  3. 3Hellenic Republic Ministry of Health, Athens, Greece
  1. Correspondence to Vasiliki-Kalliopi Bournia; lily_bournia{at} and Petros P Sfikakis; psfikakis{at}


Objectives Depression and anxiety are linked bi-directionally with inflammatory rheumatic diseases (IRDs) activity, which in turn, depends on subjective patient reported outcomes that can be distorted by comorbid mood disorders. We tested the hypothesis that introduction and/or switching of biologic agents for IRDs are associated with treatment for depression and/or anxiety, by analysing real-world data.

Methods Using a country-wide electronic prescription database (10 012 604 registered, 99% population coverage), we captured almost all patients with rheumatoid arthritis (n=12 002), psoriatic arthritis (n=5465) and ankylosing spondylitis (n=6423) who received biologic disease modifying anti-rheumatic drugs (bDMARDs) during a 2-year period (8/2016–7/2018). Concomitant antidepressant/anxiolytic medication use was documented in patients who started or switched bDMARDs and compared with those who remained on conventional synthetic (cs)DMARDs or the same bDMARD, respectively, by multivariate regression analysis.

Results Two-year data analysis on 42 815 patients revealed that bDMARD introduction was associated with both antidepressant [OR: 1.248, 95% CI 1.153 to 1.350, p<0.0001] and anxiolytic medication use [OR: 1.178, 95% CI 1.099 to 1.263, p<0.0001]. Moreover, bDMARD switching was also associated with antidepressant [OR: 1.502, 95% CI 1.370 to 1.646, p<0.0001] and anxiolytic medication use [OR: 1.161, 95% CI 1.067 to 1.264, p=0.001]. Notably, all these associations were independent of age, gender, underlying disease diagnosis and concomitant glucocorticoid or csDMARD medication use.

Conclusion In real-world settings, both introduction and switching of bDMARDs in patients with IRDs were associated with the presence of mood disorders. Although a causal relationship is uncertain, the impact of depression and anxiety should always be considered by physicians facing the decision to introduce or switch bDMARDs in patients with active IRDs.

  • Biological Therapy
  • Arthritis
  • Psoriatic
  • Arthritis
  • Rheumatoid
  • Spondylitis
  • Ankylosing

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  • Contributors VKB contributed in designing the study, statistical analysis, curation of data and drafting of the manuscript, MGGT contributed in designing the study and critically revised the manuscript, DV contributed in study conceptualisation, study design and critical revision of the manuscript, KL contributed in analysis of data, SP and KF contributed in data curation and drafting the manuscript. KM, AT and PM contributed in data curation and analysis, PPS conceived the original idea, supervised the project and contributed in study design, data analysis, writing and reviewing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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