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Research Identifies Factors Contributing to Fatigue in Patients With UC in Remission
Even when in remission, patients with ulcerative colitis (UC) may experience fatigue and lack of work productivity when they have histories of corticosteroid treatment and of arthritis, according to a study of patient-reported outcomes (PROs) published in the American Journal of Gastroenterology this month.
This study examined factors associated with PROs among UC patients in the Corrona Inflammatory Bowel Disease (IBD) Registry who were in remission.
Researchers analyzed the records of patients enrolled in the Corrona IBD Registry from May 3, 2017, through September 3, 2019, who were diagnosed with UC but were in remission, as indicated by a partial Mayo score of <2 when enrolled. The researchers reviewed the Patient-Reported Outcomes Measurement Information System (PROMIS) and the Work Productivity and Activity Impairment (WPAI) questionnaires that patients submitted at enrollment, which included patient-reported measures of fatigue, pain interference, and anxiety as moderate to severe (≥60) or normal to mild (≤60), as well as impairment in activity and work productivity.
Among 385 patients in the registry with UC in remission, those who reported moderate to severe fatigue were more likely to have a history of arthritis (n = 10/54 [18.5%] vs n = 26/325, [8%]); had been diagnosed with UC at younger age (mean, aged 33.4 years vs 39 years); and experienced higher urgency of defecation (n = 16/54 [29.6%] vs n = 52/325 [16%]) than those with normal to mild fatigue. More patients with moderate to severe fatigue also reported use of corticosteroids (n = 33/54 [61.1%] vs n = 156/325 [48%]) and antibiotics (n = 15/54 [27.8%] vs n = 49/325 [15.1%]) and had been treated for UC for shorter periods (mean, 2.3 years vs 3.3 years).
Researchers noted similar treatment trends among patients who reported moderate to severe pain interference and anxiety versus normal to mild levels of these conditions. They also found that more patients with moderate to severe fatigue reported current treatment with a biologic therapeutic agent (n = 23/54 [42.6%] vs n = 109/325 [33.5%]) compared with those with normal to mild scores.
Patients who reported any “presenteeism impairment”—those who were able to attend work but found they were less productive and efficient—were more likely to have a history of arthritis (n = 11/97 [11.3%] vs n = 11/157 [7%]); to experience greater urgency of defecation (n = 26/97 [26.8%] vs n = 24/157 [15.3%]); and to be undergoing treatment with corticosteroids (n = 11/97 [11.3%] vs n = 11/157 [7%]) compared with those who reported none of these factors.
The researchers found similar trends when comparing patients with UC in remission who reported any Work Productivity Loss to patients who did not report productivity effects. These patients were more likely to have a history of arthritis (n = 10/93 [10.8%] vs n = 10/144 [6.9%]); urgency of defecation (n = 26/93 [28%] vs n = 23/144 [16%]); and current corticosteroid treatment (n = 10/93 [10.8%] vs n = 10/144 [6.9%]).
“Despite being in remission based on partial Mayo Score, patients with UC who reported impaired work productivity or had elevated fatigue, anxiety, or pain interference were more likely to have a history of arthritis and urgency,” the researchers concluded. “History of steroid use was seen more often in patients with impaired PROMIS scores. Further investigation is needed to address the unmet medical needs in these patients.”
--Rebecca Mashaw
Reference:
Horst S, Hudesman D, Zhuo J, et al. Factors associated with impaired patient-reported outcomes and work productivity among patients with ulcerative colitis in remission. Am J Gastroenterol. 2020; 115(S10)
