What Is the Effect of TNF Inhibitors on Employment Status in Rheumatoid Arthritis Patients and What Are the Predictors of Progression to Unemployment?

Andrew Chow¹, Regan Arendse², Wojciech Olszynski², John Kelsall³, Milton F. Baker⁴, William G Bensen⁵, Philip Baer⁶, Anna Jaroszynska⁷, Denis Choquette⁸, Suneil Kapur⁹, Jacqueline Stewart¹⁰, Emmanouil Rampakakis^11,12, Eliofotisti Psaradellis¹², Francois Nantel¹³, Susan Otawa¹⁴, Cathy Tkaczyk¹⁴, Allen J Lehman¹⁴ and Karina Maslova¹³, ¹University of Toronto/McMaster University, Mississauga, ON, Canada, ²University of Saskatchewan, Saskatoon, SK, Canada, ³Mary Pack Arthritis Centre, Vancouver, Vancouver, BC, Canada, ⁴VIHA, Victoria, BC, Canada, ⁵St Joseph's Healthcare Hamilton, Hamilton, ON, Canada, ⁶Section on Rheumatology, Ontario Medical Association/Journal of the Canadian Rheumatology Association, Toronto, ON, Canada, ⁷Private Practice, Burlington, ON, Canada, ⁸Rheumatology Department, Institut de Rhumatologie de Montréal and University of Montreal, Montreal, QC, Canada, ⁹Rheumatology, University of Ottawa, Ottawa, ON, Canada, ¹⁰Penticton Regional Hospital, Penticton, BC, Canada, ¹¹JSS Medical Research, St-Laurent, QC, Canada, ¹²JSS Medical Research, Montreal, QC, Canada, ¹³Janssen Inc., Toronto, ON, Canada, ¹⁴Medical Affairs, Janssen Inc., Toronto, ON, Canada

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Anti-TNF therapy and rheumatoid arthritis (RA), Employment

Session Information

Date: Monday, November 9, 2015

Title: Health Services Research Poster II (ACR): Healthcare Access, Patterns of Medication Use and Workforce Considerations

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose:

Rheumatoid arthritis (RA) is a chronic, progressive inflammatory disease which has been associated with an increased incidence of disability and unemployment over time. The aim of this analysis was to evaluate the prevalence of unemployment due to work disability in RA patients initiating treatment with infliximab (IFX) or golimumab (GLM) and to identify determinants of disability.

Methods:

BioTRAC is an ongoing, prospective registry of patients initiating treatment for RA, AS, or PsA with IFX or GLM as first biologics or after having been treated with a biologic for <6 months. Data were obtained from RA patients treated with IFX (2002-2014) or GLM (2010-2014). Between employment group differences were assessed for statistical significance with the independent samples t-test or the chi-square. Time to employment and time to unemployment were assessed with the Kaplan-Meier (KM) estimator of the survival function. Cox regression was used to identify predictors of time to unemployment.

Results:

A total of 581 RA patients were included; 374 (64.4%) employed and 207 (35.6%) unemployed due to disability. The following baseline parameters were associated with significantly increased likelihood of being unemployed due to disability: female vs. male gender (40.1% vs. 27.6%; P=0.006), earlier enrolment period (2002-05 vs. 2006-09 vs. 2010-14: 49.3% vs. 30.5% vs. 22.4%; P<0.001), insurance type (provincial vs. private vs. both: 54.9% vs. 23.8% vs. 20.0%; P<0.001), older age (P=0.033), and increased disease activity as evidenced by the higher DAS28 (P<0.001), SJC (P<0.001), TJC (P<0.001), HAQ (P<0.001), MDGA (P<0.001), PtGA (P<0.001), CDAI (P<0.001), SDAI (P<0.001), pain (P<0.001), and ESR (P<0.001).

Among disabled patients, 10.1% were able to return to work upon treatment with TNF a mean KM-based duration of 119.5 months from baseline; whereas 6.4% of employed patients became disabled (2002-05 vs. 2006-09 vs. 2010-14: 7.0% vs. 10.1% vs. 1.7%; P=0.021) with a mean time to unemployment of 113.4 months. Multivariate survival analysis showed that, upon adjusting for enrolment period, higher baseline HAQ [HR (95%CI): 3.59 (1.64, 7.87), P=0.001], and higher baseline SJC [HR (95%CI): 1.09 (1.02, 1.16), P=0.011] were significant predictors of unemployment due to disability.

Conclusion:

A significant proportion of RA patients are unemployed due to disability in Canada. At anti-TNF initiation, work disability was associated with higher disease activity, female gender, earlier enrolment period, and provincial insurance. Increased HAQ and higher SJC were significant predictors of progression to unemployment highlighting the importance of early anti-TNF initiation in order to prevent work disability. Anti-TNF treatment was effective in enabling a considerable portion of disabled patients to return to employment.

Disclosure: A. Chow, Janssen Inc., 5; R. Arendse, Janssen Inc., 5; W. Olszynski, Janssen Inc., 5; J. Kelsall, Janssen Inc., 5; M. F. Baker, Janssen Inc., 5; W. G. Bensen, Janssen Inc., 5; P. Baer, Janssen Inc., 5,AbbVie, 5,Amgen, 5,BMS, 5,Pfizer Inc, 5,Roche Pharmaceuticals, 5; A. Jaroszynska, Janssen Inc., 5; D. Choquette, Janssen Inc., 5,AbbVie, 5,Amgen, 5,Celgene, 5,BMS, 5,Pfizer Inc, 5; S. Kapur, Janssen Inc., 5; J. Stewart, Janssen Inc., 5; E. Rampakakis, JSS, 3; E. Psaradellis, JSS Medical Research, 3; F. Nantel, Janssen Inc., 3; S. Otawa, Janssen Inc., 3; C. Tkaczyk, Janssen Inc., 3; A. J. Lehman, Janssen Inc., 3; K. Maslova, Janssen Inc., 3.

To cite this abstract in AMA style:

Chow A, Arendse R, Olszynski W, Kelsall J, Baker MF, Bensen WG, Baer P, Jaroszynska A, Choquette D, Kapur S, Stewart J, Rampakakis E, Psaradellis E, Nantel F, Otawa S, Tkaczyk C, Lehman AJ, Maslova K. What Is the Effect of TNF Inhibitors on Employment Status in Rheumatoid Arthritis Patients and What Are the Predictors of Progression to Unemployment? [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/what-is-the-effect-of-tnf-inhibitors-on-employment-status-in-rheumatoid-arthritis-patients-and-what-are-the-predictors-of-progression-to-unemployment/. Accessed .

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