Predictors of each quality of life dimension in Crohn’s disease patients initiating an anti-TNF treatment: differentiated effects of patient-, disease-, and treatment-related characteristics

Abstract

Background and aims

In Crohn’s disease (CD), a composite therapeutic target was recently recommended, including both objective measurement (endoscopic remission) and Patient-Reported Outcomes (resolution of abdominal pain and normalization of bowel function). All dimensions of health-related quality of life (HRQoL) are impacted: not only bowel symptoms but also systemic symptoms, emotional wellbeing and social function. Thus, understanding the predictors of each HRQoL dimension would improve patient management. However, analysis of these factors has only been found in a few publications, with some limitations. Therefore, this study aimed to explore the evolution of the HRQoL of CD patients during six months after initiation of anti-TNF and to identify its predictors.

Methods

We analyzed data of 56 patients included in a multicenter prospective cohort study (COQC-PIT). HRQoL measures (using IBDQ-32) and data related to patient, disease and treatment characteristics were collected every two months. Generalized estimating equations were used.

Results

Overall HRQoL was significantly improved 2 months after anti-TNF initiation, and then stagnated. Patient, disease, and treatment characteristics have differentiated impacts on the overall score and on each dimension of quality of life. Subcutaneous anti-TNF had no significant effect on overall HRQoL, improving only emotional function and bowel symptoms. Concomitant use of corticosteroids and/or immunomodulators impaired almost all dimensions. Having children or working altered bowel symptoms. Disease duration and active smoking negatively impact emotional function and systemic symptoms.

Conclusions

Each HRQoL dimension, not only bowel symptoms, and their influencing factors should therefore be considered in medical decision-making, especially in months following the initiation of a new treatment such as anti-TNF.

Keywords:

• Crohn’s disease
• IBDQ-32 dimension
• anti-TNF
• patient-reported outcomes
• health-related quality of life

Acknowledgements

We would like to thank all patients who participated in the COQC-PIT study. We also thank the François Aupetit Association (AFA), in the person of Anne Buisson, for the web-communication made on the study before the inclusions.

Disclosure statement

Caroline Trang-Poisson has served as a speaker, a consultant and an advisory board member for MSD, Abbvie, Takeda, Janssen, Tillots, Maat pharma, Mylan. Ginette Fotsing declares consulting fees for Abbvie, Janssen, MSD, Pfizer, Roche, Takeda and Tillots. The other authors declared no conflict of interests.

Author contributions

Fanny MONMOUSSEEAU, Véronique DES GARETS, Emmanuel RUSCH, Solène BRUNET-HOUDARD and Alexandre AUBOURG designed the COQC-PIT study. Laurence PICON, David LAHARIE, Ginette FOTSING, Dany GARGOT, Cloé CHARPENTIER, Anthony BUISSON, Caroline TRANG-POISSON, Nina DIB and Alexandre AUBOURG recruited the patients. Lucile MULOT performed the data analysis under the supervision of Fanny MONMOUSSEAU. Solène BRUNET-HOUDARD and Alexandre AUBOURG discussed the results. Fanny MONMOUSSEAU and Lucile MULOT drafted the manuscript. Solène BRUNET-HOUDARD and Alexandre AUBOURG provided critical revision on drafts. All authors approved the final version of the manuscript and are accountable for its content.

Additional information

Funding

The University hospital of Tours was the study sponsor. This study was funded by the University of Tours (grant number: 4500194967), in the framework of the public research program named “Ambition Research and Development 2020” dedicated to Biologics, and supported by the Centre-Val de Loire region. No pharmaceutical company had any role in the study design, data collection, analyses and interpretation of the results or the drafting of the publication.