Biologic disease-modifying antirheumatic drugs (DMARDs) were found to reduce absenteeism and increase productivity in a large meta-analysis of patients with arthritis, suggesting that these economic benefits may go a long way toward balancing the high cost of these drugs. The study was presented at the 2015 annual meeting of the European Congress of Rheumatology (EULAR).1
“Within a few years of diagnosis, a significant proportion of those suffering from rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis are no longer able to work. This has major financial consequences for individuals and society, and contributes to the high indirect costs of rheumatic diseases,” said study coauthor Cécile Gaujoux-Viala, MD, PhD, head of the Rheumatology Department at Nimes University Hospital, Nimes, France.
The meta-analysis was based on a systematic review of published studies: 15 randomized controlled trials and 7 controlled cohort studies with a total of 15,881 patients treated with biologics (adalimumab, etanercept, infliximab, certolizumab, golimumab, and abatacept) and 9713 controls. All studies evaluated the effect of biologic agents on work performance. The majority of patients had rheumatoid arthritis (RA; n = 24,670); 319 patients had ankylosing spondylitis and 605 had psoriatic arthritis (PsA).
Work-related outcomes were compared in patients and controls, and included employment status, absenteeism, and presenteeism (defined as being at work but performing at a suboptimal level).
For the total number of missed workdays at week 24, the standardized response mean was −0.034; this was calculated by dividing the change in scores by the standard deviation in scores and is thought to be a good measure of responsiveness. The number of patients who lost work hours was 46% lower in the biologic DMARD group compared with controls (odds ratio [OR], 0.54; 95% CI, 0.36-0.79).
Biologics also significantly improved presenteeism (ie, work productivity, effect size, −1.58). The risk for employment loss was 40% lower in the biologic DMARD group than in controls (OR, 0.60; 95% CI, 0.33-1.09), which was not quite statistically significant.
At a press conference, Gaujoux-Viala noted that the availability of biologic DMARDs improves the chances of controlling disease activity and preventing disease progression. “I think our treat-to-target strategy—adding biologic DMARDs when conventional DMARDs fail—will reduce the burden of rheumatoid disease,” she commented.
A related study conducted in 2012 among 90 patients with RA found that higher disease activity was associated with greater compromise in work productivity.2
A separate study evaluated factors influencing work disability in 400 patients with PsA and found that level of disease activity was associated with reduced effectiveness at work, while unemployment was associated with employer factors, age, and disease duration.3
The same group of investigators, Tillett and colleagues, presented 6-month follow-up data at EULAR from 236 employed and currently working patients with PsA treated with standard therapy: anti–tumor necrosis factors (anti-TNFs) and conventional DMARDs. The investigators saw improvement in all domains of work disability, as measured by the Work Productivity and Activity Impairment questionnaire.
“The rate and degree of improvement in work disability was greater amongst those patients who commenced on anti-TNF treatment (P <.0001) compared with standard DMARD therapy. Presenteeism, the primary end point, amongst those who commenced on anti-TNFs improved from 48% impairment to 10% compared with those who commenced on conventional DMARDs who improved from 30% to 20%,” Tillett wrote in an email.
- Tubery A, Castelli C, Erny F, et al. The effect of biological agents on work in patients with chronic inflammatory arthritides: a meta-analysis of randomized controlled trials and controlled cohorts. Presented at: 16th Annual European Congress of Rheumatology; June 10-13, 2015; Rome, Italy. Abstract OP0148.
- Chaparro Del Moral R, Rillo OL, Casalla L, et al. Work productivity in rheumatoid arthritis: relationship with clinical and radiological features. Arthritis. 2012:137635.
- Tillett W, Shaddick G, Askari A, et al. Factors influencing work disability in psoriatic arthritis: first results from a large UK multicentre study. Rheumatology (Oxford). 2015;54(1):157-162.