Biologics Improve Work Performance in Rheumatic Diseases

Pam Harrison

June 26, 2015

ROME — In patients with rheumatic diseases, biologic disease-modifying antirheumatic drugs (DMARDs) can reduce absenteeism and increase productivity, which could help offset the high cost of their use, a new meta-analysis suggests.

"Chronic inflammatory diseases already confer a significant economic burden for patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis," Cécile Gaujoux-Viala, MD, from Nîmes University Hospital in France, told reporters attending a news conference.

In fact, one-fifth of patients with rheumatic conditions are forced to change careers, and one-third will have stopped working 2 years after symptom onset. Within 10 years, half will be unable to work at all.

"I think the high cost of biologic DMARDs could be partly offset by the savings they demonstrate in indirect costs, such as reduced absenteeism, missed work days, and improved productivity," said Dr Gaujoux-Viala.

Results from the meta-analysis were presented here at the European League Against Rheumatism Congress 2015.

The 15 randomized controlled trials and seven controlled cohort studies that looked at the effect of biologic agents on work performance involved 15,881 patients; the majority of people had rheumatoid arthritis, but some had psoriatic arthritis or ankylosing spondylitis.

Dr Gaujoux-Viala and her colleagues assessed work-related outcomes — including employment status, absenteeism, and presenteeism, which is defined as being at work but not performing at an optimal level — in the 15,881 patients treated with a biologic agent and 9713 control patients treated with nonbiologic agents.

Treat to Target

"Biologic agents significantly reduced absenteeism, with a moderate effect on cumulative missed days at work at 6 months and a significant reduction in the number of patients losing hours of work," Dr Gaujoux-Viala reported.

For accumulated missed workdays at week 24, the standardized response mean, calculated by dividing the change in scores by the standard deviation of change in scores — and one of the best measures to estimate responsiveness — was –0.34.

The number of patients losing work hours was 46% lower in the biologic DMARD group than in the control group (odds ratio [OR], 0.54; 95% confidence interval, 0.36 - 0.79).

Biologic agents also significantly improved productivity at work, or presenteeism (effect size, –1.58).

The risk for employment loss was 40% lower in the biologic DMARD group than in the control group (OR, 0.60); this almost reached significance.

"The addition of biologic DMARDs has improved the possibility of controlling disease activity and preventing the progression of joint damage," Dr Gaujoux-Viala said.

"I think our treat-to-target strategy — where we add biologic DMARDs when conventional DMARDs fail — will really reduce the burden of rheumatoid disease," she explained.

Real-World Effectiveness

"Our findings are consistent with the findings from this meta-analysis," William Tillett, MD, from the Royal National Hospital for Rheumatic Diseases in Bath, United Kingdom, told Medscape Medical News.

His team conducted an observational study of the real-world effectiveness of tumor necrosis factor (TNF) inhibitors and DMARDS in 400 patients with psoriatic arthritis (Rheumatology [Oxford]. 2015;54:157-162).

"We found that there was greater and more rapid improvement in all forms of work disability, including absenteeism and presenteeism," with biologic DMARDs than with conventional DMARDs.

For too many years, physicians were focused on physician-centered outcomes in rheumatic diseases, he explained.

"That has dramatically changed. If you can give patients a drug that makes them feel better, so that they are able to return to work, surely that's more meaningful than measuring a biomarker," Dr Tillett added.

Dr Gaujoux-Viala reports serving as a consultant for AbbVie, BMS, Janssen Pharmaceutica Products LP, MSD, Nordic-Pharma, Pfizer, UCB, and Roche Pharmaceuticals. Dr Tillett reports receiving grant and research support from AbbVie.

European League Against Rheumatism (EULAR) Congress 2015. Abstract OP0148. Presented June 11, 2015.


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