Effect of TNF antagonists on the productivity of daily work of patients with rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is a significant cause of work disability and job loss. The resulting economic burden experienced by patients has received considerable research attention. This research assesses the effect of tumor necrosis factor (TNF) antagonists (infliximab, etanercept) on the ability of RA patients living in Japan to work and participate in society. A total of 42 patients with active RA were enrolled and given biological therapy for 12 months (mo). Of these patients, 14 were employed full-time, 6 were employed part-time, and 22 were not employed. Twenty-six patients were given infliximab, and sixteen were given etanercept. The amount of domestic labor performed before the biologics served as a baseline and was assigned a value of 0%. After treatment with biologics, the productivity was evaluated using the visual analog scale (VAS; -100 to +100 mm). The administration of TNF antagonists to RA patients who exhibited an insufficient response to medical treatment significantly improved the Disease Activity Score 28 (DAS 28) after both 6 mo and 12 mo (P , 0.0001). A significant correlation was found between the improvement in their DAS 28 and improvements in their work situation (Productivity VAS) (P , 0.05). Of particular interest is the significant correlation between the values of baseline mHAQ and the percent changes of Productivity VAS that was observed after 6 mo and 12 mo (P , 0.05). Our findings indicate that medical treatment of RA with TNF antagonists improves the patients' ability to perform their jobs and housekeeping. Because loss of productivity is an important contributor to the indirect costs of RA, our findings are relevant for the pharmacoeconomic assessment of treatments.

Impact of Adalimumab on Work Productivity and Activity Impairment in Japanese Patients with Rheumatoid Arthritis: Large-Scale, Prospective, Single-Cohort ANOUVEAU Study

“…Significant decreases in DAS28CRP obtained in this real-world setting were consistent with those reported in clinical trials of 24- to 52-week duration, as well as a 24-week post-marketing surveillance study conducted in Japan [ 27 , 39 , 47 , 48 ]. Importantly, in the present large-scale study, improvements in WPAI/RA showed a weak to moderately strong positive linear correlation with improvement in disease activity, extending the findings from a previous small-scale study assessing the effects of TNF-α antagonists on DAS28ESR and work productivity in 42 patients [ 15 ].…”

“…These results are within the range presented in a systematic literature review evaluating randomized controlled trials showing the effect of biologics on the reduction in days of sick leave (ranging from 2.1 days in 4 weeks to 18.7 days in 2 years) [ 49 ]. A favorable effect of biologics on daily work-related productivity has been reported in Japan [ 15 ]. Concomitant use of MTX was also a factor associated with presenteeism, OWI, and AI, and shorter disease duration was another factor associated with AI for HMs in the present study.…”

“…In addition to early treatment, combination treatment with conventional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (MTX), and biologic DMARDs, such as those targeting tumor necrosis factor-α (TNF-α; infliximab, etanercept, and adalimumab [ADA; AbbVie Inc., North Chicago, IL, USA]), interleukin-6 (IL-6; tocilizumab), IL-1 (anakinra), or T cells (abatacept) provide favorable short- and long-term outcomes [ 13 , 14 ]. Results of multiple studies (including several conducted in Japan) also indicate that TNF-α inhibitors such as etanercept and infliximab improve patients’ employability and ability to perform work and housekeeping tasks [ 4 , 15 – 20 ].…”

“…Although the efficacy and safety of ADA have been clearly established in patients with RA, including its effect on work ability, workplace and household productivity, and QoL in studies conducted around the world [ 19 , 28 – 32 ], large-scale evidence of its long-term impact on work productivity and activity impairment (WPAI) in Japan is lacking [ 15 , 33 ]. This real-world Adalimumab Non-interventional Trial for Up-verified Effects and Utility (ANOUVEAU) study was conducted to evaluate the effects of ADA on RA-related work productivity and activity impairment (RA-related WPAI), as well as the association of disease activity changes on work outcomes in routine rheumatology care in Japan.…”