Rheumatology (Oxford). 2025 Nov 7:keaf598. doi: 10.1093/rheumatology/keaf598. Online ahead of print.
ABSTRACT
OBJECTIVES: While biologic or targeted synthetic DMARDs (b/tsDMARDs) improve mental status in RA patients with high disease activity, their effects after achieving low disease activity (LDA) or remission are unclear. We compared the effectiveness of b/tsDMARDs on mental status in RA patients who had reached treatment targets.
METHODS: We analyzed RA patients who achieved LDA or remission using b/tsDMARDs. Mental health was assessed at baseline and 1 year using the Hospital Anxiety and Depression Scale (HADS). Minimal clinically important difference (MCID) thresholds were calculated. Using weighted generalized linear models with propensity score overlap weighting, we estimated the relative risk (RR) of achieving clinically meaningful improvement, defined as an improvement exceeding the MCID threshold for HADS anxiety (HADS-A) or depression (HADS-D) (primary outcome), and analyzed the change in HADS subscale scores (secondary outcome) comparing b/tsDMARDs classes.
RESULTS: A total of 363 treatment courses from 328 RA patients were analyzed. Compared with tumour necrosis factor inhibitor (TNFi) treatment, non-TNF-targeted therapies were associated with higher rates of clinically meaningful improvement in HADS-A (RR 1.80, 95% CI 1.25-2.59) and HADS-D (RR 1.44, 95% CI 1.02-2.06). Among these, IL-6 receptor inhibitors (IL-6Ri) and Janus kinase inhibitors (JAKi) were associated with a significant improvement in anxiety. No significant difference was observed in HADS-D improvement across b/tsDMARD classes.
CONCLUSION: In RA patients who achieved treatment targets, non-TNF-targeted therapies, particularly IL-6Ri and JAKi, significantly improved anxiety and depression at one year compared with TNFi.
PMID:41206652 | DOI:10.1093/rheumatology/keaf598
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