(287) Psychotropic medication in end-stage patients with cystic fibrosis

Background: Mental health symptoms are prevalent in patients with cystic fibrosis (CF). [1] Severe lung function impairment has been correlated with depressive symptoms. [2] With increased use of highly effective modulator therapy (HEMT), concerns have arisen about the impact on psychiatric conditions. This study reports changes in psychiatric symptoms and psychotropic medications in end-stage patients with CF over the first 2 years of HEMT.

Methods: All patients eligible for HEMT were approached for enrollment. Participants were given four mental health measures: Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), Patient-Reported Outcomes Measurement Information System (PROMIS)- Depression/Anxiety. These were administered at baseline (HEMT initiation) and 1, 3, 6, 9, 12, 18, 24 months. Median differences between baseline and 24 months were analyzed. Charts were reviewed for history of psychiatric diagnoses and medications. For this analysis, patients who were started on HEMT therapy via compassionate use/expanded access programs prior to FDA approval were included, as these reflected the most severe cases in our cohort.

Results: After 2 years on HEMT therapy, 17 participants (ages = 18-52 years, 53% male) were identified. All participants had severe lung disease (FEV1 >40). Three were followed by palliative care. At baseline, participants had history of anxiety (53%), depression (59%), and sleep difficulties (35%). Psychotropics were prescribed for 65% of participants. At 24 months, one participant had discontinued all psychiatric medications. Three participants decreased number and/or dosage of psychotropics. Most maintained consistency in type, dosage, and scheduling of psychotropics. At 24 months, none experienced worsening of psychiatric symptoms requiring dosage increases or initiation of new medications. All participants are still living.

Overall, baseline median scores were below the clinical threshold on all measures. Wilcoxon sign-rank test was used to compare differences in the measures at each time points. PHQ-9 showed a significant change in median score from 5.00 (IQR 2.25,9.50) at baseline to 1.00 (IQR: 0.00, 2.75) at 24 months (p=0.003). Neither GAD-7 nor PROMIS-Anxiety/Depression scores demonstrated a significant change over 24 months.

Conclusions: Patients with end-stage CF did not present with clinically significant mental health symptoms at HEMT initiation or 24 months later, although many were already on psychotropic medications. Statistically significant improvement in depressive symptoms on the PHQ-9 were noted, although clinical relevance is unknown. Some psychotropic adjustments included discontinuation or lowering psychotropic dosage over 2 years; no patients increased doses or initiated new psychotropic medications.

Acknowledgements:

References: [1] Quittner AL, Goldbeck L, Abbott J, Duff, A, Lamrecht P, Sole A et al. Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: results of The International Depression Epidemiological Study across nine countries. Thorax. 2014;69: 1090–1097. https://doi: 10.1136/thoraxjnl-2014-205983.

[2] Riekert K, Bartlett SJ, Boyle MP, Krishnan JA, Rand CS. The association between depression, lung function, and health-related quality of life among adults with cystic fibrosis. Chest. 2007;132(1):231-237. https://doi: 10.1378/chest.06-2474.