medwireNews: Pharmacotherapy for rheumatoid arthritis (RA) does not meaningfully improve mental health outcomes for the majority of patients, researchers report.
Faith Matcham (King’s College London, UK) and colleagues conducted a systematic review and network meta-analysis of 57 randomized controlled trials of biologic DMARD treatments in RA patients, involving a total of 23,535 participants.
Overall, biologic DMARDs were associated with a “statistically significant but modest” improvement in mental health-related quality of life – as measured by the SF36 Mental Component Summary (MCS) score – relative to comparators, which could be placebo, conventional DMARDs, or other biologics, with a standardized mean difference (SMD) of 0.21
This indicates that biologics were related to a treatment effect of around one-fifth of a standard deviation compared with control treatments on average, which is equivalent to an approximate 2-point difference in MCS score, explain Matcham and colleagues.
They add that by comparison, the impact of biologic treatments on SF36 Physical Component Summary (PCS) scores was “somewhat larger,” at an SMD of 0.41, which equates to a difference of around 4 points in PCS scores.
When the analysis was limited to placebo-controlled studies, biologics were not associated with a significant improvement in MCS scores, and they had “consistently small effect sizes” when compared with conventional DMARDs. The largest effect on mental health was seen for interleukin-6 inhibitors versus conventional DMARDs.
The team also identified “a small but significant” association between disease duration and mental health, with every increased year of disease duration linked to a 0.04-point decrease in biologic treatment efficacy as indicated by the MCS.
Together, these findings suggest that mental health problems “must be addressed” in patients with RA, and “are unlikely to resolve with effective RA pharmacological disease management alone,” write the researchers in Arthritis & Rheumatology.
And they conclude: “Providing integrated, dedicated [mental health] care within routine practice is essential to achieve parity of esteem, valuing mental and physical health equally.”
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