Fatigue is a systemic extraintestinal disease manifestation largely independent of disease activity, chronicity, and nutritional deficiencies in inflammatory bowel disease on biologics

Abstract

Background

Fatigue is a common symptom reported by patients with chronic immunoinflammatory diseases and with profound negative implications on health-related quality of life. This study aimed to delineate underlying components contributing to fatigue in patients with inflammatory bowel disease (IBD) receiving biologic therapy.

Methods

Cross-sectional questionnaire study of all patients with IBD receiving any biologic therapy at a tertiary IBD center. Fatigue was assessed by Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F). Disease activity and quality of life were evaluated by generic questionnaires. Principal component analysis (PCA) was used to identify components of variables explaining fatigue.

Results

Three hundred patients with IBD were included. Moderate-to-severe fatigue defined as FACIT-F ≤ 39 was present in half of the included patients. PCA condensed variables associated with fatigue into three main components contributing to 49% of observed fatigue. The first component, explaining 21% of fatigue, included factors related to disease chronicity, e.g., long disease duration, high number of previously used biologic therapies, presence of previous intestinal surgery, and increasing age. The second component explained 14% of fatigue and comprised disease activity-related aspects, e.g., disease activity indices and C-reactive protein. The third explained 14% of fatigue and comprised various nutritional deficiencies.

Conclusion

Fatigue can partly be explained by chronicity, disease activity, and nutritional deficits. However, the cause of fatigue is unexplained in approximately half of the patients with IBD supporting that fatigue can be an independent, systemic extraintestinal disease manifestation in IBD.

Keywords:

• Inflammatory bowel disease
• biologics
• fatigue
• Crohn’s disease
• ulcerative colitis

Disclosure statement

KRC has served on the advisory board for Gilead Nordics and has received unrestricted grants from Pfizer and Gilead Nordics. CS has served as a speaker and advisory board member for MSD. JB has been a consultant and/or advisory board member and received fees and/or research grants from Abbvie, Pfizer, MSD, Takeda, Janssen, and Gilead. MS has received research grants from Eli Lilly and Pfizer. TSJ has served as a speaker and consultant for AbbVie, Pfizer, Roche, Novartis, UCB, Biogen, Gilead, and Eli Lilly. LEK has served as a speaker and consultant for Pfizer, AbbVie, Amgen, UCB, Gilead, Biogen, BMS, MSD, Novartis, Eli Lilly, and Janssen, and has received research grants from Pfizer, AbbVie, UCB, Biogen, Novartis, Eli Lilly, and Janssen. MAA and SB declare no conflicts of interest.

Presentation

The study was accepted for poster presentation at the 16th Congress of ECCO, 2021, virtual.

Data availability statement

The data that support the findings of this study are available from the corresponding author (KRC), upon reasonable request.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.