Background/Purpose:

Rheumatoid arthritis (RA) is a chronic inflammatory disease that can progress to joint destruction, functional impairment and disability that can lead to work productivity losses. Biologics are generally prescribed when conventional disease modifying agents are no longer effective or following disease progression. Treatment with etanercept (ETN), either as monotherapy or in combination with methotrexate (MTX), has been shown to improve functioning and work productivity in clinical and observational studies. The aim of this study was to assess the productivity benefit of treating RA patients with ETN compared to MTX.

Methods:

In this retrospective administrative claims analysis using the MarketScan Health and Productivity Management and the Commercial Claims and Encounters databases, adults diagnosed with RA who were treated with ETN, ETN+MTX, or MTX between January 1, 2007 and December 31, 2013 were identified. The index date was the date of the earliest qualifying ETN or MTX pharmacy or medical claim. Patients were continuously enrolled with medical and pharmacy benefits 12 months prior to and 12 months following the index date. Patients who switched to or added another biologic during the post-index period were excluded. Patients diagnosed with other autoimmune diseases or had evidence of pregnancy or childbirth at any time during the study period were excluded. The proportions of patients with any workplace absence (ABS) or short-term disability (STD) in the 12 months prior to and following the index date were evaluated. Multivariable logistic regression was used to compare the odds of work loss during follow-up for the ETN and ETN+MTX groups relative to the MTX group, adjusting for demographic and baseline clinical characteristics including but not limited to age, gender, additional RA-related medications, and baseline RA-related costs.

Results:

For the work loss due to ABS analysis, 34 patients on ETN monotherapy, 49 patients on ETN+MTX, and 308 patients on MTX monotherapy were identified. For the STD analysis, 207 patients on ETN, 274 patients on ETN+MTX, and 1,620 patients on MTX were identified. The proportions of patients with at least one event of ABS during the pre-index period for the ETN, ETN+MTX, and MTX cohorts were 82.4%, 73.5%, and 85.4%, respectively. In the post-index period, the proportions of patients with at least one event of ABS for the ETN, ETN+MTX and MTX cohorts were 85.3%, 75.5%, and 87.0%, respectively.

The proportion of patients with at least one event of STD during the pre-index period for the ETN, ETN+MTX and MTX cohorts were 8.7%, 13.9%, and 11.5%, respectively. In the post-index period, the proportion of patients with at least one event of STD for the ETN, ETN+MTX and MTX cohorts were 7.7%, 8.4%, and 11.7%, respectively. After adjusting for potential confounders, the odds (95%CI) of losing a day due to ABS in the ETN and ETN+MTX groups relative to the MTX group were 0.61(0.19-1.98) and 0.33(0.13-0.85), respectively. The odds (95%CI) of having STD in the ETN and ETN+MTX groups relative to the MTX group were 0.61(0.35-1.07) and 0.50(0.30-0.84), respectively.

Conclusion:

Adding ETN to MTX reduces the probability of ABS from work by 67% and the probability of STD by 50% compared to those on MTX alone.

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/work-productivity-benefit-in-patients-with-rheumatoid-arthritis-initiating-etanercept-in-the-united-states/