Pos0584-Hpr pros and Disease Activity in Year Prior to Covid Predict Trajectories of Depression in Adults With Ra in First 2 Years of Pandemic: Data From the Canadian Early Arthritis Cohort

Abstract

BackgroundGrowing evidence points to considerable mental health impacts of the prolonged COVID-19 pandemic, though data from longitudinal studies in rheumatic diseases are sparse.ObjectivesWe explored distinct trajectories ofdepressive symptoms in the year prior to and throughout the first 2-years of the COVID-19 pandemic inadults with RA.MethodsCATCH is a prospective multi-center study of adults with early RA (symptoms <1 year; 81% met 2010 ACR/EULAR criteria at enrolment) who receive care from rheumatologists across Canada. Prior to the pandemic, participants completed PROs and rheumatologists conducted RA assessments during scheduled in-person study visits. After March 2020, ongoing collection of PROs continued at in-person and remote visits.We used group-based trajectory modeling to identify latent groups with at least mild depression (PROMIS 4a depression score ≥55) in participants with ≥1 visits in the year prior to the pandemic (3/19-2/20) and ≥1 visits during pandemic (3/20-1/22) and identified prepandemic individual and clinical characteristics and PROs associated with each trajectory.ResultsThe analytic sample included 989 participants with a mean (SD) age of 60 (14) and disease duration of 6 (4) years. 73% were women, 84% white, 60% had completed some post-secondary education, and 77% were in CDAI REM/LDA at visit closest to the start of pandemic.The best model included 4 groups (posterior probabilities ≥0.80 for each group): 1)Resilient(none-minimal depression throughout: N=594; 60%);Worsening(none/minimal to mild: N=222;22%);Improving(mild-resilient: N=80;8%); andPersistent(moderate-severe throughout: N=93;9%)(Figure 1).As compared with the Resilient group, those with Worsening Depression were more likely to be female, have a higher prepandemic CDAI, MD and patient global, and report worse pain, disability, anxiety, depression, fatigue, sleep disturbance, and lower participation (Table 1).Figure 1.Table 1.Mean(SD); N(%)Worsening N=222 (22%)Resilient N=594 (60%)Improving N=80 (8%)Persistent N=93 (9%)SIGAge60 (15)61 (13)59 (13)61 (13)0.538Female173 (78%)406 (68%)57 (71%)74 (80%)0.016White194 (87%)533 (90%)67 (84%)71 (76%)0.004Education > high school143 (64%)388(65%)56 (70%)42 (45%)0.001RDCI (excl depression)1.2 (1.2)1.0 (1.2)1.0 (1.1)1.0 (1.1)0.174CDAI6.7 (8.2)5.4 (8.5)11.3 (13.9)13.0 (13.1)<0.001csDMARDs ±MTX198 (89%)547 (92%)73 (91%)67 (94%)0.513MTX only153 (69%)436 (73%)62 (78%)67 (72%)0.443Biologic or JAK43 (19%)102 (17%)12 (15%)26 (28%)0.073Corticosteroids36 (16%)86 (14%)26 (33%)20 (22%)0.001Patient Global3.1 (2.4)1.2 (2.1)3.9 (2.9)5.3 (2.7)<0.001PROMIS Anxiety >5597 (44%)44 (7%)58 (73%)86 (92%)<0.001PROMIS Depression >5583 (37%)13 (2%)70 (88%)90 (97%)<0.001PROMIS Fatigue >5583 (37%)94 (16%)42 (53%)74 (80%)<0.001PROMIS Pain >55125 (56%)187 (31%)55 (69%)76 (82%)<0.001PROMIS Physical Function <45132 (59%)238 (40%)51 (64%)78 (84%)<0.001PROMIS Participation <45107 (48%)141 (24%)49 (61%)72 (77%)<0.001PROMIS Sleep Problems >5562 (28%)88 (15%)33 (41%)so (54%)<0.001ConclusionAlthough 60% of Canadian RA patients had consistently good mental health during the first 2 years of the COVID-19 pandemic, more than 1 in 5 reported deteriorating mood suggesting a cumulative impact over time; 9% had persistent depression and 8% improving mood. The proportion of adults with RA with at least mild symptoms of depression may be more than twice that reported for the general Canadian population. Participants with worsening depressive symptoms during the pandemic were more likely to be female, have higher prepandemic disease activity, symptoms, disability, and higher impairments in participation. Given the impact of depression on quality of life, inflammation, and disease management, vulnerable groups may benefit from more frequent evaluation and additional support from rheumatology providers.AcknowledgementsCATCH was designed and implemented by the investigators and financially supported through unrestricted research grants from: Amgen and Pfizer Canada since 2007; AbbVie Canada since 2011; Medexus since 2013; Sandoz Canada since 2019; Fresenius Kabi Canada since 2021; Organon Canada since 2021.Previous funding from Hoffman La Roche (2011-21); Sanofi Genzyme (2016-7); Eli Lilly Canada (2016-20); Merck Canada (2017-21) and; Gilead Sciences Canada (2020-21).Disclosure of InterestsSusan J. Bartlett Speakers bureau: Janssen, Merck, Organon, Pfizer, Sandoz, Consultant of: Janssen, Merck, Organon, Orit Schieir: None declared, Marie-France Valois: None declared, Janet Pope Speakers bureau: UCB. Sandoz, Consultant of: AbbVie, Actelion, Amgen, Bayer, BMS, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Grant/research support from: Abbvie, BMS, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Louis Bessette Speakers bureau: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Grant/research support from: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Gilles Boire Speakers bureau: Merck, BMS, Pfizer, Janssen, Consultant of: Amgen, BMS, Celgene, Eli Lilly, Pfizer, Grant/research support from: Amgen, Abbvie, BMS, Eli Lilly, Merck, Novartis, Pfizer, Sandoz, Carol Hitchon Grant/research support from: Pfizer, UCB, Edward Keystone Speakers bureau: Amgen, AbbVie, Bristol-Myers Squibb, F. Hoffmann-La Roche Inc., Janssen Inc., Merck, Pfizer Pharmaceuticals, Sanofi Genzyme, UCB, Consultant of: AbbVie, Amgen, AstraZeneca Pharma, Bristol-Myers Squibb Company, Celltrion, Myriad Autoimmune, F. Hoffmann-La Roche Inc, Genentech Inc, Gilead, Janssen Inc, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, Sandoz, Sanofi-Genzyme, Samsung Bioepsis, Grant/research support from: AbbVie, Amgen, Gilead Sciences, Lilly Pharmaceuticals, Merck, Pfizer Pharmaceuticals, PuraPharm, Sanofi, Carter Thorne Speakers bureau: Medexus/Medac, Consultant of: Abbvie, Amgen, Celgene, Centocor, Janssen, Lilly, Mexexus/Medac, Merck, Novartis, Pfizer, Sanofi, Grant/research support from: Abbvie, Celgene, CaREBiodam, Diane Tin: None declared, Glen Hazlewood: None declared, Vivian Bykerk Grant/research support from: Amgen, BMS, Genzyme, Pfizer, Regeneron Sanofi Aventis, UCB.