Depression, Anxiety, Pain Predictive of TNFi Discontinuation for Inflammatory Arthritis

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Patients who had depression, anxiety, and chronic pain were more likely to discontinue TNFi therapy.

Among patients with inflammatory arthritis, earlier discontinuation of tumor necrosis factor (TNF)-inhibitor therapy was associated with co-occurring symptoms of depression, anxiety, and chronic pain and use of opioids. These findings were published in the jounral Clinical Rheumatology.

This retrospective cohort study sourced data from Optum’s de-identified ClinformaticsÒ Data Mart Database. Between 2000 and 2014, patients (N=33,744) with rheumatoid arthritis (RA; n=23,888), psoriatic arthritis (PsA; n=6443), and ankylosing spondylitis (AS; n=3413) were assessed for predictors of TNFi discontinuation within 2 years of starting therapy.

The RA, PsA, and AS cohorts comprised patients aged mean 52.7, 48.7, and 45.2 years; 75.6%, 50.4%, and 45.5% were women; 53.4%, 41.9%, and 18.7% used concurrent methotrexate; and 45.8%, 23.1%, and 26.0% used concurrent glucocorticoids, respectively.

The risk factors of interest (depression/anxiety, chronic pain, and opioid use) were more common among patients with AS than RA or PsA (P <.001). The presence of ≥1 risk factor was observed among 48.1% of the RA, 42.5% of the PsA, and 55.4% of the AS cohorts. Multiple risk factors co-occurred most often among patients with AS, in which 16.6% had 2 risk factors and 6.1% had all 3.

Median TNFi persistence was 1.28 years for the RA, 1.54 for the PsA, and 1.20 for the AS cohorts. Among all patient cohorts, the presence of any risk factor was associated with decreased TNFi persistence of between 5 and 7 months, with hazard ratios (HRs) for treatment discontinuation ranging from 1.27 to 1.41.

Compared with no risk factors, having one risk factor increased odds of TNFi discontinuation with adjusted HRs (aHRs) between 1.18 to 1.22 and having all 3 risk factors, between 1.46 to 1.85.

This study was limited by not having access to information about disease severity or treatment efficacy.

The study authors identified that patients who had depression, anxiety, chronic pain, and those who used opioids were more likely to discontinue TNFi therapy than patients without these risk factors. Additional study is needed to assess whether addressing these comorbid symptoms may improve disease management.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Katz G, Ogdie A, Baker JF, George MD. Association between depression, anxiety, chronic pain, or opioid use and tumor necrosis factor inhibitor persistence in inflammatory arthritis.Clin Rheumatol. Published online January 27, 2022. doi:10.1007/s10067-021-06045-3