The finding:
This study sought to look at the impact of a pre-existing mood disorder in patients with inflammatory bowel disease (IBD) on continuation with anti-tumor necrosis factor (TNF) biologic therapy and subsequent adverse outcomes related to treatment ineffectiveness. Researchers found that having an active mood disorder in 2 years prior to anti-TNF therapy associated with higher rate of biologic discontinuation in first year of therapy, though they did not find a significant difference in IBD-related adverse outcomes during same period. The scope of the study did not include reasons for discontinuation of biologic or severity and remission status of mood disorders.  

Strength and weaknesses:
Strengths include a large study population and access to records through existing enrollment of IBD patients through a pre-existing database. Weaknesses include the study’s reliance on retrospective chart review with mood disorders only considered active if the criteria met within 2 years of biologic initiation, thereby limiting the definition of mood disorders to mood disorder-related doctors’ visits or prescriptions. This approach potentially misses patients who did not seek care with overt psychiatric complaints as well as overestimates active disorders by not considering the lesser impact of mood disorders in remission.

Relevance:
It is still unclear if intervention on mood disorders would increase compliance on anti-TNF treatment, however, this study highlights the importance for C-L psychiatrists to be aware of the higher risk of medication discontinuation among patients with pre-existing anxiety and depression. C-L psychiatrists need to work closely with patient and GI doctors to monitor and facilitate the best chance of medication adherence.

Type of study (EBM guide):
Cohort study