Vedolizumab Therapy Is Associated with an Improvement in Sleep Quality and Mood in Inflammatory Bowel Diseases

Abstract

Introduction Poor sleep, depression, and anxiety are common in patients with inflammatory bowel diseases (IBD) and associated with increased risk of relapse and poor outcomes. The effectiveness of therapies in improving such psychosocial outcomes is unclear but is an important question to examine with increasing selectivity of therapeutic agents. Methods This prospective cohort enrolled patients with moderate-to-severe CD or UC starting biologic therapy with vedolizumab or anti-tumor necrosis factor α agents (anti-TNF). Sleep quality, depression, and anxiety were measured using validated short-form NIH PROMIS questionnaires assessing sleep and mood quality over the past 7 days. Disease activity was assessed using validated indices. Improvement in sleep and mood scores from baseline was assessed, and regression models were used to identify determinants of sleep quality. Results Our study included 160 patients with IBD (49 anti-TNF, 111 Vedolizumab) among whom half were women and the mean age was 40.2 years. In the combined cohort, we observed a statistically significant and meaningful decrease in mean scores from baseline (52.8) by week 6 (49.8, p = 0.002). Among vedolizumab users, sleep T-score improved from baseline (53.6) by week 6 (50.7) and persisted through week 54 (46.5, p = 0.009). Parallel reductions in depression and anxiety were also noted (p < 0.05 by week 6). We observed no difference in improvement in sleep, depression, and anxiety between vedolizumab and anti-TNF use at week 6. Conclusions Both vedolizumab and anti-TNF biologic therapies were associated with improvement in sleep and mood quality in IBD.

Sleep Impairment and Psychological Distress among Patients with Inflammatory Bowel Disease—beyond the Obvious

“…The link between corticosteroid use and poor sleep might represent one argument for opting for corticosteroid-sparing agents in targeting the control of IBD activity. Moreover, a prospective study conducted by Stevens and collaborators demonstrated that the use of anti-TNF therapy and vedolizumab might even lead to an improvement in sleep, depression, and anxiety in patients with moderate to severe IBD, highlighting this aspect within 6 weeks of therapy, which was maintained up to 1 year [19]. Among the other types of medication in our IBD patient group, there was no statistically significant difference in PSQI scores, which might suggest that this type of medication is either associated with a less severe disease phenotype (aminosalicylates) or with a better control of disease activity and less psychological distress (biological therapy and azathioprine).…”

The influence of the brain–gut axis in inflammatory bowel disease and possible implications for treatment

“…In IBD, observational studies of patients with CD and UC newly-commenced on either anti-TNF therapy or vedolizumab have demonstrated improved depression scores following treatment. 71,76 However, neither of these studies accounted for the potential confounding effect of glucocorticosteroid tapering on psychological wellbeing in their analyses.…”

Fatigue in Inflammatory Bowel Diseases: Etiologies and Management

“…Considering the effect of inflammation on sleep, it is intuitive that by decreasing disease activity, significant improvement in sleep can be achieved. Patients treated with vedolizumab and anti-TNF medications showed significant improvement in sleep survey scores with reduced nocturnal diarrhea and less abdominal pain [121]. It is also important for clinicians to identify iatrogenic risk factors for sleep impairment and modify treatment regimens.…”