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Understanding the Link Between bDMARD Initiation, Switching With Mood Disorders

October 02, 2020

Both the introduction and switching of biologic disease modifying anti-rheumatic drugs (bDMARDs) were associated with the use of depression and anxiety medications in a real-world population of patients with inflammatory rheumatic diseases. Researchers published their findings online in RMD Open. 

“To conclude,” they wrote in the study, “depression and anxiety that are bidirectionally related with inflammatory rheumatic diseases, may contribute to bDMARD initiation and switching in these patients, either by aggravating disease severity and/or by distorting the perception of patient-reported outcome measures. Mood disorders should be always considered by practicing rheumatologists upon the decision to propose to an ‘inadequately treated’ patient the introduction or switching of a biologic agent.” 

The study focused on 42,815 patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis in Greece. Researchers looked at antidepressant and anxiolytic medication use in patients who started or switched bDMARDs over a 2-year period compared with patients who remained on conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) or the same bDMARD. 

Researchers found a positive association between the use of antidepressant and anxiolytic medication with both the introduction and switching of bDMARDs. Odds ratios for bDMARD introduction were 1.248 with antidepressant use and 1.178 with anxiolytic use, according to the study. Odds ratios for bDMARD switching were 1.502 with antidepressant use and 1.161 for anxiolytic use. 

“Notably,” researchers pointed out, “these associations were independent of age, gender, underlying disease, and concomitant glucocorticoid or csDMARD use.” 

Jolynn Tumolo


Bournia VK, Tektonidou MG, Vassilopoulos D, et al. Introduction and switching of biologic agents are associated with antidepressant and anxiolytic medication use: data on 42 815 real-world patients with inflammatory rheumatic disease. RMD Open. 2020;6(3):e001303. doi:10.1136/rmdopen-2020-001303

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