Do interventions for mood improve inflammatory biomarkers in Inflammatory Bowel Disease?: A Systematic Review and Meta-Analysis

Description

Meta-analysis of RCTs in adults with IBD that trialled interventions that included mood (depression, anxiety, stress, distress, or poor emotional well-being) as a primary or secondary outcome. All studies had to include an inflammatory biomarker, measured pre- and post-intervention. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Five electronic databases (in MEDLINE, EMBASE, PsycINFO, Global Health (through Ovid, 2022) and Web of Science (through Clarivate 2022), from 1947 to October 2023) were searched. Independent reviewers screened studies, extracted data, and assessed methodological quality. Data were pooled to estimate standardised mean differences (SMD) with 95% Confidence Intervals (CIs). A random-effects robust variance estimation accounted for studies measuring multiple biomarkers. Intervention type, mood as a primary or secondary outcome, effect on mood outcomes and IBD subtype were investigated as treatment effect moderators. Where there were sufficient biomarkers, individual meta-analyses were run (Pre-registration PROSPERO: CRD42023389401). 28 RCTs involving 1789 participants met inclusion criteria. Interventions demonstrated small, statistically significant effects on biomarkers (-0.35, 95%CI:-0.48, -0.22, p<0.001) and medium effects on mood outcomes (-0.50, 95%CI:-0.73, -0.27, p<0.001), without evidence of substantive heterogeneity or publication bias. Individual analyses showed small effects for improved faecal calprotectin (-0.19, 95%CI:-0.34, -0.03, p=0.018) and C-Reactive Protein (-0.29, 95%CI: -0.47, -0.10, p=0.002). Effect sizes were larger for psychological therapy interventions (compared with exercise or antidepressants) and when there was an effect (SMD≥0.2) on mood.

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