Effective Infliximab Treatment for CD Is Associated With Improved Mental Health

Crohn disease (CD) can involve physical, psychological, and social impairments that negatively impact patients’ quality of life, and high levels of anxiety and depression have been observed in patients with CD. A study in Chinese patients, recently published in Patient Preference and Adherence, sought to evaluate changes in illness perceptions, coping strategies, psychological well-being, and quality of life in patients newly diagnosed with CD and treated with infliximab, and found that effective therapy led to both remission of CD and improved psychological status.

The researchers followed 82 patients with CD who were newly diagnosed between September 2014 and December 2016. Disease severity was evaluated using the Harvey—Bradshaw Index (HBI), and patients also answered 4 questionnaires: the Brief Illness Perceptions Questionnaire, the Brief Coping Operations Preference Enquiry, the Hospital Anxiety and Depression Scale, and the Inflammatory Bowel Disease Questionnaire.

With infliximab treatment, 59 patients (72%) achieved clinical remission at week 14, and patients’ responses to the above questionnaires demonstrated significant improvements in illness perceptions, maladaptive coping, anxiety, depression, and quality of life. By week 30, 58 patients (70.7%) achieved clinical remission, and also reported significant improvements in illness perceptions, maladaptive coping, anxiety, depression, and quality of life versus baseline. Emotion-focused coping and problem-focused coping remained unchanged at weeks 14 and 30 from baseline, however.

For the patients who did not achieve clinical remission with infliximab treatment, psychological characteristics did not show any significant improvement after treatment.

The findings on maladaptive coping, say the authors, are notable because previous longitudinal research on patients with inflammatory bowel disease have shown that maladaptive coping did not change over time with treatment, but most patients in a prior study did not receive infliximab or another anti—tumor necrosis factor therapies, but instead were treated mainly with 5-aminosalicylic acid and immunomodulators. The rapid and effective treatment with infliximab, they suggest, may explain why patients in the current study had better improvement and adopted fewer maladaptive strategies.

While the researchers acknowledge that their study was limited by the fact that HBI (rather than mucosal healing) was used to gauge remission, the findings of this study, say the authors, suggest that interventions that help to reduce a patient’s disease activity may also help to improve psychological characteristics.

Reference

Zhang M, Zhang T, Hong L, et al. Improvement of psychological status after infliximab treatment in patients with newly diagnosed Crohn’s disease. Patient Prefer Adherence. 2018;12:879-885. doi: 10.2147/PPA.S156883.