Effect of Infliximab on Major Depressive Episode in a Sample of Iraqi Patients with Ankylosing Spondylitis at Baghdad Teaching Hospital

Abstract

Background: Infliximab is a biological therapy used to treat ankylosing spondylitis, may be effective in the treatment of depression accompanying it.

Objectives: To assess the effect of infliximab on depressive disorder and severity in patients with ankylosing spondylitis (AS).

Patients and Methods: A randomly selected study enrolled AS patients diagnosed according to the modified New York criteria for ankylosing Spondylitis. Activity of disease was measured using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Active disease as defined by BASDAI ≥4.0. every patient assessed mentally by mini-international neuropsychiatric interview (MINI) and if there is depressive episode then diagnosed according to ICD-10 criteria for depression. Beck Depression Inventory (BDI) was used to evaluate depression severity. Infliximab was administered (5 mg/kg) at 0, 2 weeks and 6 weeks and then every 6weeks. Collected data include age, education, employment.  BASDAI and BDI were assessed prior to the initial infliximab dose and at the subsequent doses. Data were collected in period between 1^st October 2013 to 15 march 2014.

Results: A total of 46 patients with ankylosing spondylitis were enrolled in this study, the mean age was 35.1 ± 8.5 years, 63% aged 30-39 years. The majority of patients (71.7%) had secondary school and lower level of education, employed patients were 18(39.1 %). Severe depression was found in 69.6%, moderate depression in 28.2%, mild depression in 2.2%. It had been found that frequency of severe depression reduced significantly with the advancing doses of infliximab (p< 0.001). After the last dose of infliximab, depression was improved in majority of patients (73.9%). No significant association had been found between the improvement in depression neither with age, level of education nor the occupation. (p>0.05).

Conclusion: The improvement of depression was among two thirds of AS patients, after three doses of Infliximab, and this improvement of depression was associated significantly with inactivity of ankylosing spondylitis disease.

Keywords: Ankylosing spondylitis, Depression, Infliximab.