Background/Purpose: Patients with axial spondyloarthritis (axSpA) identify the ability to stay at work as a priority. Biologic therapy improves disease activity and quality of life but evidence is equivocal on whether it improves work outcomes.

Methods: BSRBR-AS is a prospective study of patients with axSpA, recruited from eighty five centres throughout Great Britain, who are naïve to biologic therapy. Patient recruitment commenced in December 2012. We compared work outcomes (using the Work Productivity and Activity Impairment Index (WPAI:SHP)) in those commencing biologic therapy at the time of recruitment with those who did not. Adjustment for differences in characteristics (age, Bath indices of disease activity (BASDAI) function (BASFI) global status (BAS-G), and smoking) was by propensity score matching to obtain estimates of treatment effect one year after commencing such therapy. .

Results: A total of 201 patients commencing biologics and 627 not commencing biologics have been followed up for one year and were eligible for the current analysis. The study population had a mean age of 53.5 years, a mean duration since diagnosis of 14.6 years, 71.6% were male and 67.8% were HLA‑B27 positive. Patients who were commencing biologic therapy were younger (47.9 v. 55.3 years), more likely to be current smokers (22% v. 11.5%), with greater disease activity (BASDAI mean 6.3 v. 3.8), poorer function (BASFI mean 6.3 v. 3.8), and worse global status (BAS-G mean 7.0 v.3.8)(all p < 0.001). At recruitment they reported more absenteeism (13.0% v. 3.0%); more presenteeism (41.5% v. 19.9%) greater productivity impairment (43.3% v. 20.6%); and greater overall activity impairment (59.9% v. 32.5%). At follow-up, biologics patients reported improvements across absenteeism (-7.5%), presenteeism (-30.0%), productivity impairment (-32.2%), and overall activity impairment (-41.3%)). After adjustment, biologics patients demonstrated a significantly greater improvement (compared to those not starting biologic therapy) in presenteeism (-12.4%; 95% CI=-22.7, -2.0). There was also greater improvement in absenteeism (-3.9%; -14.4, 6.6); greater reduction in productivity impairment (-8.6%; -20.1, 2.8) and greater reduction in overall activity impairment (-7.3%, -15.2, 0.5) although these differences were not statistically significant.

Conclusion: After taking account of differences between groups, treatment with biologic therapy was associated with greater improvement in measures of work (particularly a reduction in presenteeism) amongst patients with axSpA, compared to those not starting biologic therapy. Thus biologic therapy delivers improved outcomes likley to have important economic benefits.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/are-work-outcomes-improved-in-axial-spondyloarthritis-axspa-patients-with-biologic-therapy-results-from-the-british-society-for-rheumatology-register/