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Abstract Number: 992

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

Jakub Zavada1, Lenka Szczukova2, Karel Pavelka3 and Jiri Vencovsky3, 1Institute of Rheumatology, Prague, Czech Republic, 2Institute of Biostatistics and Analyses. Faculty of Medicine, Masaryk University, Brno, Czech Republic, 3Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Ankylosing spondylitis (AS), Psoriatic arthritis, registry and rheumatoid arthritis (RA), Work Disability

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Session Information

Date: Monday, November 6, 2017

Session 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.

Table 1. Baseline characteristics

RA (n = 352)

AS (n= 442)

PSA (n= 133)

p-value*

Female

257 (73.0 %)

104 (23.5 %)

58 (43.6 %)

< 0.001 ABC

Disease duration

7.1 ± 5.7

7.0 ± 6.7

7.5 ± 7.2

0.245

Age at start of anti-TNF therapy

47.2 ± 8.9

39.5 ± 8.6

44.4 ± 9.1

< 0.001  ABC

HAQ

1.5 ± 0.5

1.2 ± 0.5

1.2 ± 0.6

< 0.001  AB

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)

Table 2. The effect of one year of anti-TNF therapy on WPAI-SHP components across diagnoses.

Dg.

WPAI –SHP component

Baseline

12 months

Mean change after 12 months

Number of assessed patients

P-value*

RA

Absenteeism

12.8 (27.9)

5.1 (18.5)

7.7 (30.3)

203

< 0.001

Presenteeism

52.1 (21.9)

27.6 (20.9)

24.5 (26.3)

183

< 0.001

Overall work impairment

53.9 (22.8)

28.7 (22.0)

25.2 (26.9)

183

< 0.001

Activity impairment

62.4 (21.4)

36.0 (23.0)

26.4 (27.7)

352

< 0.001

AS

Absenteeism

10.6 (25.6)

3.5 (15.8)

7.1 (28.0)

307

< 0.001

Presenteeism

53.1 (22.2)

21.1 (18.0)

32.0 (24.9)

282

< 0.001

Overall work impairment

54.8 (22.6)

21.8 (18.8)

33.0 (25.5)

281

< 0.001

Activity impairment

60.7 (22.1)

27.3 (21.4)

33.5 (26.4)

442

< 0.001

PSA

Absenteeism

5.7 (17.3)

4.2 (18.4)

1.5 (24.6)

90

0.135

Presenteeism

43.9 (24.0)

15.3 (16.2)

28.6 (24.5)

84

< 0.001

Overall work impairment

45.2 (25.0)

15.9 (16.8)

29.3 (25.1)

84

< 0.001

Activity impairment

57.4 (24.6)

26.2 (21.3)

31.2 (26.5)

133

< 0.001

Values are mean %(SD). * Wilcoxon paired test for difference between baseline and 12 months within each WPAI score.

Table 3 Prediction of improvement in overall work impairment

 

Predictor

Univariate analysis

Multivariate analysis

β(95% CI)

p-value

β (95%  CI)

p-value

Diagnosis: RA

reference

reference

Diagnosis: AS

7.83 (3.01; 12.65)

0.001

6.67 (1.12; 12.23)

0.019

Diagnosis: PSA

4.128 (-2.555; 10.812)

0.226

5.85 (-0.79; 12.50)

0.084

Gender (male)

reference

reference

Gender (female)

-5.10 (-9.52; -0.67)

0.024

-2.87 (-7.65; 1.90)

0.238

Age at start of anti-TNF therapy

-0.41 (-0.65; -0.17)

0.001

-0.35 (-0.61; -0.10)

0.006

Disease duration

-0.25 (-0.59; 0.09)

0.151

-0.19 (-0.52; 0.14)

0.252

Ln (CRP)

3.64 (1.62; 5.67)

< 0.001

1.90 (-0.10; 3.90)

0.062

HAQ

11.49 (7.33; 15.64)

< 0.001

14. 21 (9.99; 18.43)

< 0.001


Disclosure: J. Zavada, None; L. Szczukova, None; K. Pavelka, None; J. Vencovsky, Samsung Bioepis Co., Ltd., Biogen, 5.

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 January 27, 2021.
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