The impact of biologics on health-related quality of life in patients with inflammatory bowel disease

Abstract

Background:Inflammatory bowel disease (IBD) is characterized by a chronic relapsing inflammation of the gastrointestinal tract. Adult IBD patients suffer from a disabling disease which greatly affects health-related quality of life (HRQoL). A worse HRQoL in these patients may result in a defensive and ineffective use of medical attention and thus higher medical costs. Because of its chronic nature, IBD may also cause psychological problems in many patients which may also influence HRQoL and care-seeking behavior. An important factor reducing HRQoL is disease activity. Induction of remission and long-term remission are important goals for improving HRQoL. Furthermore, remission is associated with a decreased need for hospitalization and surgery and increased employment, which in turn improve HRQoL. Treatment strategies available for many years are corticosteroids, 5-aminosalicylates and immunnosuppressants, but these treatments did not show significant long-term improvement on HRQoL. The biologics, which induce rapid and sustained remission, may improve HRQoL.Objective:To review and evaluate the current literature on the effect of biologics on HRQoL of IBD patients.Methods:We performed a MEDLINE search and reviewed the effect of different biologics on HRQoL. The following subjects and synonyms of these terms were used: inflammatory bowel disease, Crohn’s disease, ulcerative colitis, quality of life, health-related quality of life, fatigue, different anti-TNF medication, and biologicals/biologics (MESH). Studies included were limited to English-language, adult population, full-text, randomized, double-blind, placebo-controlled in which HRQoL was measured.Results:Out of 202 identified articles, 8 randomized controlled trials (RCT) met the inclusion criteria. Two RCTs on infliximab showed significant improvement of HRQoL compared to placebo which was sustained over the long term. One RCT on adalimumab showed a significant and sustained improvement of HRQoL compared to placebo. This study showed also significant decrease of fatigue in the adalimumab-treated patients. Three RCTs on certolizumab showed a significant improvement of HRQoL in the intervention group compared to placebo. Two RCTs of natalizumab treatment were found. One study showed significant and sustained improvement compared to placebo, and also scores of HRQoL comparable to that in the general population, but in the other no significant results were found.Conclusion:The biologics infliximab, adalimumab, certolizumab, and natalizumab demonstrated significant improvement of HRQoL of IBD patients compared with placebo. However, we found differences in improvement of HRQoL between the different biologics.

Physical fitness and physical activity in fatigued and non-fatigued inflammatory bowel disease patients

“…Previously it was shown that optimal management of disease activity, stress, and coping is effective to reduce fatigue [13,[81][82][83][84]. Despite that [60].…”

Systematic review with network meta‐analysis: the efficacy of anti‐TNF agents for the treatment of Crohn's disease

“…11,12 Retrospective and nonrandomised studies have demonstrated IFX and ADA to have similar clinical outcomes in avoidance of corticosteroids, surgery, hospitalisation and improvement in quality of life in patients with CD. [13][14][15][16][17] In summary, biologic and retrospective clinical data suggest similar therapeutic activity of these agents in CD. Head-to-head direct comparative efficacy trials among anti-TNF agents for CD have not been performed.…”

An evaluation of health care expenditures in Crohn's disease using the United States Medical Expenditure Panel Survey from 2003 to 2013

“…9,10 In 2008, the Food and Drug Administration (FDA) approved two self-injectable biologics (adalimumab and certolizumab pegol) for treatment of moderate to severe Crohn's disease. Recently, in 2012, the FDA approved vedolizumab for a similar indication.…”