Sustained improvement in work outcomes in employed patients with rheumatoid arthritis during 2 years of adalimumab therapy: an observational cohort study

Frank Behrens, Hans-Peter Tony, Michaela Koehm, Eva C Schwaneck, Holger Gnann, Gerd Greger, Harald Burkhardt, Marc Schmalzing, Frank Behrens, Hans-Peter Tony, Michaela Koehm, Eva C Schwaneck, Holger Gnann, Gerd Greger, Harald Burkhardt, Marc Schmalzing

Abstract

Objective: The goal of this study was to evaluate the long-term impact of adalimumab therapy on work-related outcomes in employed patients with rheumatoid arthritis (RA).

Method: We utilized data from an observational cohort of German patients who initiated adalimumab treatment during routine clinical care. Analyses were based on employed patients (part-time or full-time) who continued adalimumab treatment for 24 months. Major outcomes were self-reported sick leave days in the previous 6 months, absenteeism, presenteeism, and total work productivity impairment as assessed by the Work Productivity and Activity Impairment (WPAI) questionnaire and disease activity assessments. The normal number of sick leave days was based on data from the German Federal Statistical Office.

Results: Of 783 patients, 72.3% were women, mean age was 47.9 years, and mean disease duration was 7.8 years. At baseline (before adalimumab initiation), 42.9% of patients had higher than normal sick leave days (> 5) in the previous 6 months. During 24 months of adalimumab treatment, 61% of patients with higher than normal sick leave days at baseline returned to normal sick leave values (≤ 5 days/6 months). Overall, mean sick leave days/6 months decreased from 14.8 days at baseline to 7.4 days at month 24. Improvements were observed in WPAI assessments and disease activity measures, although presenteeism levels remained high (32.2% at month 24).

Conclusions: Adalimumab treatment was associated with strong and sustained improvements in work-related outcomes in employed patients who continued on adalimumab for 24 months. Presenteeism appears to be the work outcome most resistant to improvement during RA treatment.

Trial registration: NCT01076205 Key Points • Long-term adalimumab therapy was associated with sustained improvements in work outcomes in patients with rheumatoid arthritis. • Despite improvements in sick leave days and work absenteeism, presenteeism (impairment while at work) remained relatively high.

Keywords: Absenteeism; Adalimumab; Presenteeism; Rheumatoid arthritis; Therapeutic effects; Work performance.

Conflict of interest statement

FB, H-PT, MK, ECS, HB, and MS have served as consultants to AbbVie Deutschland GmbH & Co. KG and have received research funding, speaker fees, or compensation for consultation from AbbVie. HG is a paid consultant for AbbVie. GG is a former employee of AbbVie and may own AbbVie stock.

Figures

Fig. 1
Fig. 1
Proportion of patients who achieved normal sick leave duration (≤ 5 days in the previous 6 months) during adalimumab treatment by baseline sick leave days
Fig. 2
Fig. 2
Mean change from baseline (month 0) to month 24 in absenteeism (% of missed work hours) and presenteeism (% of impairment at work) as assessed by the Work Productivity and Activity Impairment questionnaire

References

    1. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388(10055):2023–2038. doi: 10.1016/S0140-6736(16)30173-8.
    1. Manders SH, Kievit W, Braakman-Jansen AL, Brus HL, Hendriks L, Fransen J, van de Laar MA, van Riel PL. Determinants associated with work participation in patients with established rheumatoid arthritis taking tumor necrosis factor inhibitors. J Rheumatol. 2014;41(7):1263–1269. doi: 10.3899/jrheum.130878.
    1. van Vilsteren M, Boot CR, Knol DL, van Schaardenburg D, Voskuyl AE, Steenbeek R, Anema JR. Productivity at work and quality of life in patients with rheumatoid arthritis. BMC Musculoskelet Disord. 2015;16:107. doi: 10.1186/s12891-015-0562-x.
    1. Hansen SM, Hetland ML, Pedersen J, Østergaard M, Rubak TS, Bjorner JB. Effect of rheumatoid arthritis on longterm sickness absence in 1994-2011: a Danish cohort study. J Rheumatol. 2016;43(4):707–715. doi: 10.3899/jrheum.150801.
    1. Verstappen SMM. Rheumatoid arthritis and work: the impact of rheumatoid arthritis on absenteeism and presenteeism. Best Pract Res Clin Rheumatol. 2015;29(3):495–511. doi: 10.1016/j.berh.2015.06.001.
    1. Merkesdal S, Ruof J, Huelsemann JL, Mittendorf T, Handelmann S, Mau W, Zeidler H. Indirect cost assessment in patients with rheumatoid arthritis (RA):comparison of data from the health-economic patient questionnaire HEQ-RA and insurance claims data. Arthritis Rheum. 2005;53(2):234–240. doi: 10.1002/art.21080.
    1. Braakman-Jansen LMA, Taal E, Kuper IH, van de Laar MAFJ. Productivity loss due to absenteeism and presenteeism by different instruments in patients with RA and subjects without RA. Rheumatology (Oxford) 2012;51(2):354–e61. doi: 10.1093/rheumatology/ker371.
    1. Huscher D, Mittendorf T, von Hinüber U, Kӧtter I, Hoese G, Pfӓfflin A, Bischoff S, Zink A, Centres GCA. Evolution of cost structures in rheumatoid arthritis over the past decade. Ann Rheum Dis. 2015;74(4):738–745. doi: 10.1136/annrheumdis-2013-204311.
    1. Lenssinck MLB, Burdorf A, Boonen A, Gignac MA, Hazes JMW, Luime JJ. Consequences of inflammatory arthritis for workplace productivity loss and sick leave: a systematic review. Ann Rheum Dis. 2013;72(4):493–505. doi: 10.1136/annrheumdis-2012-201998.
    1. van der Zee-Neuen A, Putrik P, Ramiro S, Keszei AP, Hmamouchi I, Dougados M, Boonen A. Large country differences in work outcomes in patients with RA – an analysis in the multinational study COMORA. Arthritis Res Ther. 2017;19(1):216. doi: 10.1186/s13075-017-1421-y.
    1. Krüger K, Wollenhaupt J, Lorenz HM, Rӧther E, Wittig BM. Reduction in sickness absence in patients with rheumatoid arthritis receiving adalimumab: data from a German noninterventional study. Rheumatol Int. 2012;32(12):3977–3983. doi: 10.1007/s00296-011-2317-9.
    1. Hussain W, Janoudi N, Noorwali A, Omran N, Baamer M, Assiry EH, et al. Effect of adalimumab on work ability assessed in rheumatoid arthritis disease patients in Saudi Arabia (AWARDS) Open Rheumatol J. 2015;9:46–50. doi: 10.2174/1874312901409010046.
    1. Zirkzee EJM, Sneep AC, de Buck PDM, Allaart CF, Peeters AJ, Ronday HK, Westedt ML, le Cessie S, Vliet Vlieland TPM. Sick leave and work disability in patients with early arthritis. Clin Rheumatol. 2008;27(1):11–19. doi: 10.1007/s10067-007-0642-x.
    1. Emery P, Smolen JS, Ganguli A, Meerwein S, Bao Y, Kupper H, Chen N, Kavanaugh A. Effect of adalimumab on work-related outcomes scores in patients with early rheumatoid arthritis receiving methotrexate. Rheumatology (Oxford) 2016;55(8):1458–1465. doi: 10.1093/rheumatology/kew056.
    1. Takeuchi T, Nakajima R, Komatsu S, Yamazaki K, Nakamura T, Agata N, Igarashi A, Tango T, Tanaka Y. Impact of adalimumab on work productivity and activity impairment in Japanese patients with rheumatoid arthritis: large-scale, prospective, single-cohort ANOUVEAU study. Adv Ther. 2017;34(3):686–702. doi: 10.1007/s12325-017-0477-z.
    1. Eriksson JK, Wallman JK, Miller H, Petersson IF, Ernestam S, Vivar N, van Vollenhoven RF, Neovius M. Infliximab versus conventional combination treatment and seven-year work loss in early rheumatoid arthritis: results of a randomized Swedish trial. Arthritis Care Res. 2016;68(12):1758–1766. doi: 10.1002/acr.22899.
    1. Zhang W, Bansback N, Boonen A, Young A, Singh A, Anis AH (2010) Validity of the Work Productivity and Activity Impairment questionnaire – general health version in patients with rheumatoid arthritis. Arthritis Res Ther 12:R177. 10.1186/ar3141
    1. Reilly Associates (2002) WPAI scoring. . Accessed 8 July 2019
    1. Prevoo ML, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38(1):44–48. doi: 10.1002/art.1780380107.
    1. Bruce B, Fries JF. The health assessment questionnaire (HAQ) Clin Exp Rheumatol. 2005;23(Suppl 39):S14–S18.
    1. Federal Statistical Office (Destatis) (2017) Quality of employment. Dimension 2: income and indirect benefits from employment. Staff on sick leave
    1. Marschall J, Hildebrandt S, Sydow H, Nolting HD (2017) Gesundheitsreport 2017. medhochzwei Verlag, Heidelberg
    1. Sokka T, Kautiainen H, Pincus T, Verstappen SMM, Aggarwal A, Alten R, Andersone D, Badsha H, Baecklund E, Belmonte M, Craig-Müller J, da Mota LM, Dimic A, Fathi NA, Ferraccioli G, Fukuda W, Géher P, Gogus F, Hajjaj-Hassouni N, Hamoud H, Haugeberg G, Henrohn D, Horslev-Petersen K, Ionescu R, Karateew D, Kuuse R, Laurindo IM, Lazovskis J, Luukkainen R, Mofti A, Murphy E, Nakajima A, Oyoo O, Pandya SC, Pohl C, Predeteanu D, Rexhepi M, Rexhepi S, Sharma B, Shono E, Sibilia J, Sierakowski S, Skopouli FN, Stropuviene S, Toloza S, Valter I, Woolf A, Yamanaka H, QUEST-RA Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA study. Arthritis Res Ther. 2010;12(2):R24. doi: 10.1186/ar2951.
    1. Søgaard R, Sørensen J, Linde L, Hetland ML. The significance of presenteeism for the value of lost production: the case of rheumatoid arthritis. Clinicoecon Outcomes Res. 2010;2:105–112. doi: 10.2147/CEOR.S11492.
    1. Noben C, Vilsteren MV, Boot C, Steenbeek R, Schaardenburg DV, Anema JR, Evers S, Nijhuis F, Rijk A. Economic evaluation of an intervention program with the aim to improve at-work productivity for workers with rheumatoid arthritis. J Occup Health. 2017;59(3):267–279. doi: 10.1539/joh.16-0082-OA.
    1. Scharbatke EC, Behrens F, Schmalzing M, Koehm M, Greger G, Gnann H, Burkhardt H, Tony HP. Association of improvement in pain with therapeutic response as determined by individual improvement criteria in patients with rheumatoid arthritis. Arthritis Care Res. 2016;68(11):1607–1615. doi: 10.1002/acr.22884.
    1. Smolen JS, Strand V, Koenig AS, Szumski A, Kotak S, Jones TV. Discordance between patient and physician assessments of global disease activity in rheumatoid arthritis and association with work productivity. Arthritis Res Ther. 2016;18(1):114. doi: 10.1186/s13075-016-1004-3.
    1. Aletaha D, Alasti F, Smolen JS. Chronicity of rheumatoid arthritis affects the responsiveness of physical function, but not of disease activity measures in rheumatoid arthritis clinical trials. Ann Rheum Dis. 2015;74(3):532–537. doi: 10.1136/annrheumdis-2013-204015.
    1. Martikainen JA, Kautiainen H, Rantalaiho V, Puolakka KT. Longterm work productivity costs due to absenteeism and permanent work disability in patients with early rheumatoid arthritis: a nationwide register study of 7831 patients. J Rheumatol. 2016;43(12):2012–2015. doi: 10.3899/jrheum.160103.
    1. Olofsson T, Söderling JK, Gülfe A, Kristensen LE, Wallman JK. Patient-reported outcomes are more important than objective inflammatory markers for sick leave in biologics-treated patients with rheumatoid arthritis. Arthritis Care Res. 2018;70(11):1712–1716. doi: 10.1002/acr.23619.
    1. Mattila K, Buttgereit F, Tuominen R. Impact of morning stiffness on working behaviour and performance in people with rheumatoid arthritis. Rheumatol Int. 2014;34(12):1751–1758. doi: 10.1007/s00296-014-3040-0.
    1. Mattila K, Buttgereit F, Tuominen R. Influence of rheumatoid arthritis-related morning stiffness on productivity at work: results from a survey in 11 European countries. Rheumatol Int. 2015;35(11):1791–1797. doi: 10.1007/s00296-015-3275-4.
    1. Callhoff J, Luque Ramos A, Zink A, Hoffman F, Albrecht K. The association of low income with functional status and disease burden in Germany patients with rheumatoid arthritis: results of a cross-sectional questionnaire survey based on claims data. J Rheumatol. 2017;44(6):766–772. doi: 10.3899/jrheum.160966.
    1. Aaltonen KJ, Ylikylä S, Tuulikki Joensuu J, Isomäki P, Pirilä L, Kauppi M, Rannio T, Eklund K, Blom M, Nordström D. Efficacy and effectiveness of tumour necrosis factor inhibitors in the treatment of rheumatoid arthritis in randomized controlled trials and routine clinical practice. Rheumatology (Oxford) 2017;56(5):725–735. doi: 10.1093/rheumatology/kew467.
    1. Vashisht P, Sayles H, Cannella AC, Mikuls TR, Michaud K. Generalizability of patients with rheumatoid arthritis in biologic agent clinical trials. Arthritis Care Res. 2016;68(10):1478–1488. doi: 10.1002/acr.22860.

Source: PubMed

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