Predictors of Return to Work During 3 Years After Start of First Tumor Necrosis Factor Antagonist in a National Cohort of Biologics-Treated Patients with Rheumatoid Arthritis

Tor Olofsson¹, Ingemar F. Petersson², Jonas Eriksson³, Martin Englund², Pierre Geborek¹, Lennart T.H. Jacobsson⁴, Johan Askling⁵ and Martin Neovius³, ¹Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden, ²Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden, ³Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden, ⁴Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, ⁵Karolinska Institutet, Stockholm, Sweden

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: anti-TNF therapy, Disability and rheumatoid arthritis (RA)

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects II: Long-term Outcome of Rheumatoid Arthritis, Observational Studies

Session Type: Abstract Submissions (ACR)

Background/Purpose: To estimate predictors of return to work during 3 years following start of anti-TNF therapy in working-age RA patients with total work disability at treatment start. Methods: RA patients aged 19-61y (n=753; mean age 53y; 80% women) starting their first anti-TNF therapy between Jan 2006 and Dec 2009 and having total work disability at treatment start (90 days with sick leave or disability pension during the 3 months preceding anti-TNF start) were identified in the Swedish biologics register (ARTIS; 92% nationwide coverage). The mean/median disease duration at bio-start was 11y/8y, 77% were on ≥1 non-biological DMARD (corticosteroids excluded). Days of sick leave and disability pension were retrieved from the Social Insurance Agency register covering all inhabitants in Sweden (data available until Oct 2010). Survival analysis was conducted with return to work ≥50% as outcome (defined as the first occurrence of a month with <15 days of sick leave or disability pension during follow-up). Baseline predictors including sex, age, education level, disease duration (counted from symptom onset), HAQ, CRP and use of non-biological DMARDs were estimated using Cox regression. The model was further adjusted for year of bio-start, health care region, unemployment status, depression and anxiety disorders, and malignancies. DAS28 was analysed in a separate model excluding HAQ (due to multi-collinearity) and CRP. Results: During the 3-year observation period after start of anti-TNF treatment the overall cumulative probability of return to work ≥50% of monthly days was 21%. The corresponding probability for patients with disease duration <5y and ≥5y was 34% and 13%, respectively (Figure; unadjusted hazard ratio [HR] for return to work ≥50% 3.0, 95%CI 2.1-4.2; adjusted HR 2.4, 95%CI 1.5-3.7). Besides this, HAQ (HR 1.6, 95%CI 1.1-2.3, per unit decrease), age at bio-start (1.8, 1.4-2.2, per 10y decrease) and education level (2.1, 1.0-4.2, for >12y vs ≤9y) were also significant predictors in adjusted analysis. This was not the case for sex (p=0.08), CRP (p=0.34) or use of non-biological DMARDs (p=0.61) at bio-start. DAS28, analysed separately, was not a statistically significant predictor after adjustment (p=0.64). Conclusion: The probability of return to work for totally disabled RA patients was higher for patients initiating anti-TNF therapy within 5 years of symptom onset. HAQ, age at bio-start and education level were also statistically significant predictors, while DAS28 and use of non-biological DMARDs were not. The results suggest that there might be a potential for increasing return to work if biological treatment was started earlier in the disease course in work disabled patients.

Disclosure:

T. Olofsson,
None;

I. F. Petersson,

Pfizer, Wyeth, Abbott, UCB Pharma,

J. Eriksson,
None;

M. Englund,
None;

P. Geborek,
None;

L. T. H. Jacobsson,

Abbot, BMS, MSD, Pfizer, UCB Pharma,

J. Askling,
None;

M. Neovius,

Pfizer Inc,

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictors-of-return-to-work-during-3-years-after-start-of-first-tumor-necrosis-factor-antagonist-in-a-national-cohort-of-biologics-treated-patients-with-rheumatoid-arthritis/