Targeted treatment does not address RA patients’ mental health

 

BIRMINGHAM, ENGLAND – Improvements in physical health with response to treatment of rheumatoid arthritis (RA) don’t necessarily translate into improvements in patients’ mental health, based on results of a systematic review presented at the British Society for Rheumatology annual conference.

Reducing levels of joint pain and inflammation did not appreciably improve mental well-being, said Faith Matcham, PhD, of the Institute of Psychiatry, Psychology, and Neuroscience, King’s College London. The standardized mean difference between biologics and disease-modifying antirheumatic drugs (DMARDs) in improving the physical and mental components of the 36-item Short Form survey were a respective 0.47 and 0.25.

Sara Freeman/Frontline Medical News

Mental health outcome effect sizes were around 50% smaller than physical health effect sizes when individual drug classes were considered versus DMARDs: Standardized mean differences were 0.23 and 0.48 for drugs targeting tumor necrosis factor, 0.19 and 0.42 for kinase inhibitors, 0.26 and 0.51 for T-cell inhibitors, and 0.21 and 0.48 for B-cell inhibitors. The largest effect size on mental health was seen with anti-interleukin–6 treatment versus DMARDs – a standardized mean difference of 0.34. The standardized mean difference for physical health was 0.44, she reported.

A pairwise meta-analysis was performed on 58 and 48 randomized controlled trials, respectively. More than 34,000 patients had been treated in these trials with 28 current or investigational RA therapies, and treatment outcomes were compared with an active, placebo, or usual-care arm. Studies were included if they had assessed any type of mood outcome.

Mental health had been measured in more than half of the RA treatment trials found on the original search, but just 40% of those trials reported mental health outcomes with enough information to be used in the meta-analyses.

Although studies that had compared biologics with placebo accounted for only four studies, none of those showed significant change in mental health outcomes with active therapy.

“Providing effective pharmacotherapy alone is going to be insufficient to produce meaningful improvement in mental health outcomes for the majority,” Dr. Matcham observed. She added that, even after treatment, mental health measures in RA patients remained lower than those in the general population. “It is essential to optimize both mental and physical health care outcomes,” she concluded, and an integrated approach needs to be taken.

Dr. Matcham reported having no financial disclosures.

 

BIRMINGHAM, ENGLAND – Improvements in physical health with response to treatment of rheumatoid arthritis (RA) don’t necessarily translate into improvements in patients’ mental health, based on results of a systematic review presented at the British Society for Rheumatology annual conference.

Reducing levels of joint pain and inflammation did not appreciably improve mental well-being, said Faith Matcham, PhD, of the Institute of Psychiatry, Psychology, and Neuroscience, King’s College London. The standardized mean difference between biologics and disease-modifying antirheumatic drugs (DMARDs) in improving the physical and mental components of the 36-item Short Form survey were a respective 0.47 and 0.25.

Sara Freeman/Frontline Medical News

Mental health outcome effect sizes were around 50% smaller than physical health effect sizes when individual drug classes were considered versus DMARDs: Standardized mean differences were 0.23 and 0.48 for drugs targeting tumor necrosis factor, 0.19 and 0.42 for kinase inhibitors, 0.26 and 0.51 for T-cell inhibitors, and 0.21 and 0.48 for B-cell inhibitors. The largest effect size on mental health was seen with anti-interleukin–6 treatment versus DMARDs – a standardized mean difference of 0.34. The standardized mean difference for physical health was 0.44, she reported.

A pairwise meta-analysis was performed on 58 and 48 randomized controlled trials, respectively. More than 34,000 patients had been treated in these trials with 28 current or investigational RA therapies, and treatment outcomes were compared with an active, placebo, or usual-care arm. Studies were included if they had assessed any type of mood outcome.

Mental health had been measured in more than half of the RA treatment trials found on the original search, but just 40% of those trials reported mental health outcomes with enough information to be used in the meta-analyses.

Although studies that had compared biologics with placebo accounted for only four studies, none of those showed significant change in mental health outcomes with active therapy.

“Providing effective pharmacotherapy alone is going to be insufficient to produce meaningful improvement in mental health outcomes for the majority,” Dr. Matcham observed. She added that, even after treatment, mental health measures in RA patients remained lower than those in the general population. “It is essential to optimize both mental and physical health care outcomes,” she concluded, and an integrated approach needs to be taken.

Dr. Matcham reported having no financial disclosures.

 

BIRMINGHAM, ENGLAND – Improvements in physical health with response to treatment of rheumatoid arthritis (RA) don’t necessarily translate into improvements in patients’ mental health, based on results of a systematic review presented at the British Society for Rheumatology annual conference.

Reducing levels of joint pain and inflammation did not appreciably improve mental well-being, said Faith Matcham, PhD, of the Institute of Psychiatry, Psychology, and Neuroscience, King’s College London. The standardized mean difference between biologics and disease-modifying antirheumatic drugs (DMARDs) in improving the physical and mental components of the 36-item Short Form survey were a respective 0.47 and 0.25.

Sara Freeman/Frontline Medical News

Mental health outcome effect sizes were around 50% smaller than physical health effect sizes when individual drug classes were considered versus DMARDs: Standardized mean differences were 0.23 and 0.48 for drugs targeting tumor necrosis factor, 0.19 and 0.42 for kinase inhibitors, 0.26 and 0.51 for T-cell inhibitors, and 0.21 and 0.48 for B-cell inhibitors. The largest effect size on mental health was seen with anti-interleukin–6 treatment versus DMARDs – a standardized mean difference of 0.34. The standardized mean difference for physical health was 0.44, she reported.

A pairwise meta-analysis was performed on 58 and 48 randomized controlled trials, respectively. More than 34,000 patients had been treated in these trials with 28 current or investigational RA therapies, and treatment outcomes were compared with an active, placebo, or usual-care arm. Studies were included if they had assessed any type of mood outcome.

Mental health had been measured in more than half of the RA treatment trials found on the original search, but just 40% of those trials reported mental health outcomes with enough information to be used in the meta-analyses.

Although studies that had compared biologics with placebo accounted for only four studies, none of those showed significant change in mental health outcomes with active therapy.

“Providing effective pharmacotherapy alone is going to be insufficient to produce meaningful improvement in mental health outcomes for the majority,” Dr. Matcham observed. She added that, even after treatment, mental health measures in RA patients remained lower than those in the general population. “It is essential to optimize both mental and physical health care outcomes,” she concluded, and an integrated approach needs to be taken.

Dr. Matcham reported having no financial disclosures.