Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are associated with significant functional impairment and work disability. In the absence of treatment, approximately 80% of RA patients will show evidence of joint abnormalities or disability, while 50% will have work disability after 10 years (1). Similarly, the prevalence of work disability in AS ranges from 13% to 45% based on the patient population (2-4). The purpose of this analysis was to evaluate the prevalence of unemployment due to work disability and determine the effect of treatment with infliximab (IFX) in patients with RA and AS in a real-world, Canadian, routine clinical practice setting
Methods:
BioTRAC is an ongoing, prospective, registry of patients initiated on treatment with IFX or golimumab as first biologics or after having been treated with a biologic for less than six months. A total of 798 RA patients and 290 AS patients initiated IFX between 2002 and 2012 and were included in this analysis.
Results:
Among the total number of RA and AS patients, 179 (22.4%) and 57 (19.7%), respectively, reported being unemployed due to their disability, while 335 (42.0%) and 77 (26.6%) were unemployed due to other reasons.
Table 1 shows the baseline patient characteristics by employment status. Patients reporting being unemployed due to disability had significantly higher disease severity. Furthermore, patients unemployed due to disability had RA for a longer period, while disease duration was comparable in AS patients across employment statuses.
By 6 months on IFX treatment, clinically meaningful and statistically significant (P<0.05) improvements in all parameters studied were observed in all three employment status groups in both RA and AS patients. No significant between-group differences in the absolute change of these disease parameters were observed upon adjustment for baseline values with the exception of BASDAI and ASDAS which showed a greater improvement in employed AS patients. Among the RA and AS patients unemployed due to disability, 10.6% and 14.0%, respectively, returned to full-time or part-time employment post baseline, the majority of whom (63.0%) within 6 months of treatment. The mean (SD) time to employment for this patient subpopulation was 10.8 (13.6) months in RA patients and 12.1 (6.6) months in AS patients.
|
Table 1: Patient Characteristics at Baseline by Employment Status |
|||||
|
Diagnosis |
Parameter: Mean (SD) or n (%) |
Unemployed due to Disability |
Unemployed due to Other Reasons |
Employed |
P-value |
|
RA |
|
n=179 |
n=335 |
n=284 |
|
|
|
Female |
138 (78.4%) |
266 (82.4%) |
184 (66.7%) |
<0.001 |
|
|
Age: years |
53.8 (10.0) |
64.5 (13.5) |
49.0 (10.9) |
<0.001 |
|
|
Disease duration: years |
11.2 (10.0) |
11.4 (10.4) |
7.7 (8.0) |
0.008 |
|
|
HAQ-DI |
1.9 (0.5) |
1.8 (0.7) |
1.3 (0.7) |
<0.001 |
|
|
SJC-28 |
12.0 (7.1) |
11.6 (7.1) |
9.2 (6.4) |
<0.001 |
|
|
TJC-28 |
15.4 (8.0) |
13.3 (7.9) |
10.3 (7.5) |
<0.001 |
|
|
PtGA: VAS mm |
67.4 (20.0) |
62.1 (23.1) |
55.6 (25.6) |
<0.001 |
|
|
Pain: VAS mm |
64.7 (20.7) |
58.7 (23.2) |
52.1 (25.2) |
<0.001 |
|
|
DAS28-ESR |
6.3 (1.3) |
6.0 (1.4) |
5.3 (1.5) |
<0.001 |
|
|
DAS28-CRP |
5.9 (1.2) |
5.5 (1.2) |
5.1 (1.4) |
<0.001 |
|
AS |
|
n=57 |
n=77 |
n=156 |
|
|
|
Female |
23 (42.6%) |
32 (44.4%) |
51 (33.3%) |
0.205 |
|
|
Age: years |
49.4 (9.1) |
50.4 (15.7) |
43.9 (10.0) |
<0.001 |
|
|
Disease duration: years |
9.0 (8.7) |
11.7 (12.3) |
9.2 (9.5) |
0.318 |
|
|
HAQ-DI |
1.5 (0.6) |
1.3 (0.6) |
1.1 (0.5) |
<0.001 |
|
|
BASDAI |
7.2 (2.1) |
6.6 (2.1) |
6.1 (2.0) |
0.002 |
|
|
ASDAS |
4.0 (0.9) |
4.0 (0.9) |
3.9 (1.1) |
0.859 |
Conclusion:
At IFX initiation, patients with work disability had more severe disease compared to patients unemployed due to other reasons or employed patients. Furthermore, RA patients had longer disease duration before being treated with IFX. However, treatment with IFX was equally effective in reducing disease severity and symptoms regardless of employment status and most importantly enabled a portion of patients to return to employment.
References:
[1] Lancet 1987;1:1108-1111.
2. Arthritis Rheum 2001;45:424-9.
3. Clin Rheumatol 2008;27:1005-13.
4. Arthritis Rheum 2008;59:497-503.
Disclosure:
W. Bensen,
Abbott, Amgen, Bristol Myers Squibb, Janssen, Merck-Schering, Lilly, Novartis, Pfizer, Wyeth, Proctor and Gamble, Roche, Sanofi, Servier, Aventis, UCB, Warner Chilcott,
5;
J. C. Thorne,
None;
S. A. Shaikh,
None;
M. K. Sheriff,
None;
S. M. Otawa,
Janssen Canada Inc,
3;
A. J. Lehman,
Janssen Canada Inc,
3;
H. Khalil,
Janssen Canada Inc,
3.
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