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Background Studies have found that depression is more frequent in patients with inflammatory bowel disease ( IBD) than the general population. Clinicians are now trying to pinpoint risk factors for psychological impairment in the IBD population. Aims To examine the demographic and phenotypic variables associated with the development of depression among a diverse cohort of IBD patients. We also sought to describe psychotropic therapy prescribed to IBD patients. Methods We conducted a retrospective cohort study including patients with Crohn's disease ( CD) and ulcerative colitis ( UC) without a prior psychiatric diagnosis and followed in the gastroenterology clinics of the private university hospital and public safety net hospital at a large academic centre in Miami (Florida). Predictive variables included demographic characteristics, IBD phenotype, exposure to IBD medications, history of a surgical stoma or seton placement, extra-intestinal manifestations, laboratory indices, aggressive disease and disease activity (based on imaging and endoscopic parameters). Proportional hazard regression models and stepwise Cox regression analysis were used for statistical analysis. Results Independent predictors of depression were female gender [ HR: 1.3 (95% CI: 1.1-1.7), P = 0.01], aggressive disease [ HR: 1.4 (95% CI: 1.02-1.9), P = 0.03] and active disease [ HR: 1.5 (95% CI: 1.1-2.0), P = 0.04]. In the group that did develop a depressive disorder, 65% received pharmacologic therapy with one or more psychotropic agents. Conclusions We found female gender, aggressive disease and increased endoscopic/radiological activity to be independently associated with the development of depression in inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

Background Antibodies against tumour necrosis factor-alpha (anti- TNF) are effective therapies in the treatment of ulcerative colitis ( UC), but their comparative efficacy is unknown. Aim To perform a network meta-analysis comparing the efficacy of anti- TNF agents in UC. Methods After screening 506 studies, reviewers extracted information on seven studies. Traditional meta-analysis ( TMA) was used to compare each anti- TNF agent to placebo. Bayesian network meta-analysis ( NMA) was performed to compare the effects of anti- TNF agents to placebo. In addition, sample sizes for comparative efficacy trials were calculated. Results Compared to placebo, TMA revealed that anti- TNF agents result in a higher likelihood of induction of remission and response ( RR: 2.45, 95% CI: 1.72-3.47 and RR: 1.65, 95% CI: 1.37-1.99 respectively) as well as maintenance of remission and response ( RR: 2.00, 95% CI: 1.52-2.62 and RR: 1.76, 95% CI: 1.46-2.14 respectively). Individually, infliximab, adalimumab and goliumumab resulted in a higher likelihood of induction and maintenance for both remission and response. NMA found nonsignificant trends in comparisons of the individual agents. The required sample sizes for direct head-to-head trials between infliximab and adalimumab for induction and maintenance are 174 and 204 subjects respectively. Conclusions This study demonstrates that, compared to placebo, infliximab, adalimumab and golimumab are all effective for the induction and maintenance of remission in ulcerative colitis. However, network meta-analysis demonstrates that no single agent is clinically superior to the others and therefore, other factors such as cost, safety, route of administration and patient preference should dictate our choice of anti- TNF agents. A randomised comparative efficacy trial between infliximab and adalimumab in UC is of practical size and should be performed. [ABSTRACT FROM AUTHOR]

A response from the authors of the article "Systematic review with network meta-analysis: the efficacy of anti-tumour necrosis factor-alpha agents for the treatment of ulcerative colitis" in the 2014 issue is presented.

A letter to the editor is presented on the use of a Bayesian-driven approach for comparing anti-tumour necrosis factor (TNF) agents for remission and response in ulcerative colitis.