Session Information
Date: Monday, November 6, 2017
Title: Epidemiology and Public Health Poster II: Rheumatic Diseases Other than Rheumatoid Arthritis
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: The ATTRA registry captures more than 95% of patients with RA, PSA or AS treated with biologics in the Czech Republic (CZ). In CZ, anti-TNF-therapy is reimbursed for RA if DAS28>5.1 despite therapy with csDMARDs, for PSA if disease is not Òadequately controlledÓ with csDMARDs and for AS if BASDAI>4 and CRP/ESR elevated above normal. To assess the effect of anti-TNF therapy on work productivity using the Work Productivity and Activity Impairment-Specific Health Problem (WPAI-SHP) questionnaire in patients with RA, PSA and AS in the real life setting using the data from ATTRA.
Methods: WPAI-SHP scores were collected for all patients enrolled in ATTRA since 2012 at baseline and after 12 months of anti-TNF exposure. BionŠive patients with RA (n=352), AS (n=442) and PSA (n=133) starting anti-TNF therapy with available baseline data on demography, disease duration and physical function, and WPAI-SHP at baseline and at 12 months were included in this analysis. Patients older than 60 years, on maternity leave or students were excluded. Only patients working for pay at baseline were assessed for WPAI-SHP summary scores: absenteeism (mean % work time missed), presenteeism (mean % productivity loss at work), overall work impairment (mean % overall work productivity loss), and activity impairment (mean % productivity loss in regular activities). Regression analyses were performed to analyse the predictors of improvement in WD overall work impairment one year.
Results: Baseline characteristics were significantly different between diagnoses (Table 1). Working status changed significantly only in patients with RA (employed 69→64%, p=0.013), but not in AS (77→78%) or PSA (77→73%). In patients employed for pay both at baseline and after 12 months, all WPAI-SHP scores improved significantly over one year of anti-TNF therapy (Table 2). Patients with AS, younger age and more pronounced functional impairement (HAQ) at start of anti-TNF therapy had most profit in terms of improvement in overall work impairment over one year (table 3).
Conclusion: In the real life setting of the CZ, anti-TNF therapy effectively reduced absenteeism, presenteeism, activity impairment and work impairment over one year in employed patients with RA, AS and PSA.
Acknowledgements: Supported by project 00023728 of Ministry of Health, CZ.
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Table 1. Baseline characteristics
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RA (n = 352)
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AS (n= 442)
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PSA (n= 133)
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p-value*
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Female
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257 (73.0 %)
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104 (23.5 %)
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58 (43.6 %)
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< 0.001 ABC
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Disease duration
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7.1 ± 5.7
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7.0 ± 6.7
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7.5 ± 7.2
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0.245
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Age at start of anti-TNF therapy
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47.2 ± 8.9
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39.5 ± 8.6
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44.4 ± 9.1
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< 0.001 ABC
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HAQ
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1.5 ± 0.5
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1.2 ± 0.5
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1.2 ± 0.6
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< 0.001 AB
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Post-hoc analysis (with Bonferroni correction): statistically significant difference btw groups A) RA vs. AS, B) RA vs. PSA, C) AS vs. PSA. Values or N (%) or mean (SD)
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Table 2. The effect of one year of anti-TNF therapy on WPAI-SHP components across diagnoses.
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Dg.
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WPAI –SHP component
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Baseline
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12 months
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Mean change after 12 months
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Number of assessed patients
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P-value*
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RA
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Absenteeism
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12.8 (27.9)
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5.1 (18.5)
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7.7 (30.3)
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203
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< 0.001
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Presenteeism
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52.1 (21.9)
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27.6 (20.9)
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24.5 (26.3)
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183
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< 0.001
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Overall work impairment
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53.9 (22.8)
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28.7 (22.0)
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25.2 (26.9)
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183
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< 0.001
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Activity impairment
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62.4 (21.4)
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36.0 (23.0)
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26.4 (27.7)
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352
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< 0.001
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AS
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Absenteeism
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10.6 (25.6)
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3.5 (15.8)
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7.1 (28.0)
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307
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< 0.001
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Presenteeism
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53.1 (22.2)
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21.1 (18.0)
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32.0 (24.9)
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282
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< 0.001
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Overall work impairment
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54.8 (22.6)
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21.8 (18.8)
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33.0 (25.5)
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281
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< 0.001
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Activity impairment
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60.7 (22.1)
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27.3 (21.4)
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33.5 (26.4)
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442
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< 0.001
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PSA
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Absenteeism
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5.7 (17.3)
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4.2 (18.4)
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1.5 (24.6)
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90
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0.135
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Presenteeism
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43.9 (24.0)
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15.3 (16.2)
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28.6 (24.5)
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84
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< 0.001
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Overall work impairment
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45.2 (25.0)
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15.9 (16.8)
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29.3 (25.1)
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84
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< 0.001
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Activity impairment
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57.4 (24.6)
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26.2 (21.3)
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31.2 (26.5)
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133
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< 0.001
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Values are mean %(SD). * Wilcoxon paired test for difference between baseline and 12 months within each WPAI score.
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Table 3 Prediction of improvement in overall work impairment
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Predictor |
Univariate analysis |
Multivariate analysis |
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β(95% CI) |
p-value |
β (95% CI) |
p-value |
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Diagnosis: RA |
reference |
reference |
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Diagnosis: AS
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7.83 (3.01; 12.65) |
0.001 |
6.67 (1.12; 12.23) |
0.019 |
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Diagnosis: PSA |
4.128 (-2.555; 10.812) |
0.226 |
5.85 (-0.79; 12.50) |
0.084 |
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Gender (male) |
reference |
reference |
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Gender (female) |
-5.10 (-9.52; -0.67) |
0.024 |
-2.87 (-7.65; 1.90) |
0.238 |
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Age at start of anti-TNF therapy |
-0.41 (-0.65; -0.17) |
0.001 |
-0.35 (-0.61; -0.10) |
0.006 |
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Disease duration |
-0.25 (-0.59; 0.09) |
0.151 |
-0.19 (-0.52; 0.14) |
0.252 |
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Ln (CRP) |
3.64 (1.62; 5.67) |
< 0.001 |
1.90 (-0.10; 3.90) |
0.062 |
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HAQ |
11.49 (7.33; 15.64) |
< 0.001 |
14. 21 (9.99; 18.43) |
< 0.001 |
To cite this abstract in AMA style:
Zavada J, Szczukova L, Pavelka K, Vencovsky J. The Effect of Anti-TNF Therapy on Work Productivity and Activity Impairment in Patients with Rheumatoid Arthritis, Ankylosing Spondylitis and Psoriatic Arthritis over One Year – Real Life Data from the Czech Biologics Registry Attra [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-effect-of-anti-tnf-therapy-on-work-productivity-and-activity-impairment-in-patients-with-rheumatoid-arthritis-ankylosing-spondylitis-and-psoriatic-arthritis-over-one-year-real-lif/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effect-of-anti-tnf-therapy-on-work-productivity-and-activity-impairment-in-patients-with-rheumatoid-arthritis-ankylosing-spondylitis-and-psoriatic-arthritis-over-one-year-real-lif/