Effect of the early use of the anti–tumor necrosis factor adalimumab on the prevention of job loss in patients with early rheumatoid arthritis

Abstract

Objective. To compare work disability and job loss in early rheumatoid arthritis (RA) patients receiving adalimumab plus methotrexate (adalimumab ؉ MTX) versus MTX alone. Methods. In this multicenter, randomized, controlled trial, patients with RA for <2 years who had never taken MTX and who self-reported work impairment were randomized to adalimumab ؉ MTX or placebo ؉ MTX for 56 weeks. Primary outcome was job loss of any cause and/or imminent job loss at or after week 16. Secondary outcomes included disease activity, function (Health Assessment Questionnaire [HAQ] score), and RA quality of life (RAQoL) questionnaire score. Work was evaluated with work diaries and the RA Work Instability Scale. Results. Although job loss during the 56-week study was significantly lower with adalimumab ؉ MTX (14 of 75 patients) compared with MTX alone (29 of 73 patients; P ‫؍‬ 0.005), the primary end point was not met (12 of 75 versus 20 of 73 patients; P ‫؍‬ 0.092), likely owing to early drop out in the MTX group. There were significant improvements in American College of Rheumatology 20% response criteria, 28-joint Disease Activity Score, ⌬HAQ, ⌬RAQoL, and working time lost in the adalimumab ؉ MTX group. Twenty-four serious adverse events were reported in 17 participants, with no differences between groups. Conclusion. Adalimumab ؉ MTX reduced job loss and improved productivity in early RA when compared with MTX alone, which supports the early use of anti-tumor necrosis factor therapy and suggests its cost efficacy.

Improvement in work place and household productivity for patients with early rheumatoid arthritis treated with adalimumab plus methotrexate: Work outcomes and their correlations with clinical and radiographic measures from a randomized controlled trial companion study

“…These data provide additional evidence of the superiority of combination treatment, which is known to lead to greater improvements in signs and symptoms of RA, functional disability, health-related quality of life, and slowing of radiographic progression than methotrexate alone (17,20). The findings complement recent studies with smaller populations and shorter study durations in which patients who received combination treatment had better work outcomes than patients who received methotrexate alone (25,26). The patterns of work outcomes for employed workers and homemakers were very similar in this study; combination treatment was superior to methotrexate for both absenteeism and presenteeism.…”

Early intervention in psoriasis and immune-mediated inflammatory diseases: A hypothesis paper

“…Treatment strategy trials have demonstrated that in the majority of patients with RA, the following approach is the most beneficial: goal-driven, dynamic treatment towards tight control of disease activity, including early introduction of one or more effective disease-modifying antirheumatic drugs (DMARDs) in combination with prednisone or anti-TNF, which includes tapering of the medication if remission or low disease activity is achieved (100). Currently, patients with RA tend to be treated first-line with a DMARD such as methotrexate (MTX) (15,16). Biologics are licensed for patients who show inadequate response or intolerance to DMARDs, and also for patients with severe, active, and progressive RA not previously treated with DMARDs (15).…”

“…As such, the treatment of IMIDs overlaps, specifically in the management of severe disease. A developing body of data suggests that more aggressive therapeutic intervention earlier in the treatment pathway in RA and CD may provide high levels of efficacy and tolerability, with improved long-term patient outcomes and disease prognosis (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). No such early intervention studies have been carried out in psoriasis to date, although the possibility of modifying the course of the disease has been proposed (27,28).…”

Early rheumatoid arthritis 6 years after diagnosis is still associated with high direct costs and increasing loss of productivity: the Swedish TIRA project

“…Previous data on working capacity after introduction of biological treatment are conflicting. Some studies have reported a decrease in sick leave (24,25), while others found no significant effect on working capacity (26)(27)(28). Two recent studies reported a decrease in sick leave, but on the other hand, increasing disability pensions (29,30).…”