Background/Purpose: We evaluated the effect of the anti-tumor necrosis factor (TNF) agents, golimumab (GLM) and infliximab (IFX), on healthcare resource utilization (HCRU) and work productivity in patients with ankylosing spondylitis (AS) in the QUality of Life as Outcomes and its VAriation with DIsease States (QUO-VADIS) study.

Methods:   This was a prospective observational study in  bionaïve AS patients (modified New York criteria) newly treated with GLM or IFX (originator) in a clinical practice setting. Patients were followed-up for ~6 months of treatment with GLM or IFX and data was collected at baseline (BL), and at 3 and 6 months.  The assessment of HCRU was done by evaluating data on the use of concomitant medications, hospitalizations (inpatient care or acute care) and visits in day care and outpatient settings; HCRU data reflected the prior 3 months for each timepoint.  Work productivity and activity impairment (WPAI) was assessed by the number of work days missed as well as quantifying absenteeism, presenteeism, work impairment, and activity using the WPAI instrument adapted to Spondylarthritis (WPAI-SpA)⁽¹⁾; WPAI was based on the 7 days prior to the administration of the questionnaire.

Results:   963 patients received ≥ 1 dose of medication.  The vast majority (78%, n=751) was treated with GLM, while the rest (22%, n=212) received IFX. Mean age of the patients was 42.7 years, 61.4% were male. Concomitant medication usage for AS treatment was reported by 84.3% of patients, the vast majority of whom received NSAIDs, followed by analgesics, DMARDs and corticosteroids. At BL, the percent of patients who reported hospitalizations (inpatient care) in the prior 3 months was 13.6%, which decreased to 3.1% at 6 months, while outpatient care in the 3 months prior to BL was reported by 39.4% of patients, which decreased to 19.0% at 6 months.  The percent of patients receiving acute emergency care in the 3 months prior to BL reduced from 1.6%0.3% at 6 months. Further details on HCRU at BL and at 6 months are shown in the Table.  The mean (SD) number of days at work, missed due to AS, was reduced from 6.3 (31.1) days at BL to 2.7 (12.3) days at 6 months.  Results for WPAI-SpA assessment are presented in the Table.

Conclusion:   In patients with AS newly treated with GLM (almost 80% of the study population) or IFX for 6 months, HCRU was reduced, as shown by the shorter mean duration of hospitalizations and the proportion of patients receiving acute, inpatient or outpatient care.  Additionally, work productivity and activity increased, and patients reported fewer days of work missed due to AS after 6 months of treatment. References: Tang et al.  Arthritis Care Res 2011; 63: S337-349 Table:  Health Care Resources Utilization and WPAI-SpA Scores

Score interpretation: For all 4 WPAI outcomes, greater scores (range 0–100%) indicate greater impact of health ⁽¹⁾