Top

Published in:

Open Access 01-09-2020 | Adalimumab | Original Article

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

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

Published in: Clinical Rheumatology | Issue 9/2020

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.

Smolen JS, Aletaha D, McInnes IB (2016) Rheumatoid arthritis. Lancet 388(10055):2023–2038. https://doi.org/10.1016/S0140-6736(16)30173-8CrossRef

Manders SH, Kievit W, Braakman-Jansen AL, Brus HL, Hendriks L, Fransen J, van de Laar MA, van Riel PL (2014) Determinants associated with work participation in patients with established rheumatoid arthritis taking tumor necrosis factor inhibitors. J Rheumatol 41(7):1263–1269. https://doi.org/10.3899/jrheum.130878CrossRefPubMed

van Vilsteren M, Boot CR, Knol DL, van Schaardenburg D, Voskuyl AE, Steenbeek R, Anema JR (2015) Productivity at work and quality of life in patients with rheumatoid arthritis. BMC Musculoskelet Disord 16:107. https://doi.org/10.1186/s12891-015-0562-xCrossRefPubMedPubMedCentral

Hansen SM, Hetland ML, Pedersen J, Østergaard M, Rubak TS, Bjorner JB (2016) Effect of rheumatoid arthritis on longterm sickness absence in 1994-2011: a Danish cohort study. J Rheumatol 43(4):707–715. https://doi.org/10.3899/jrheum.150801CrossRefPubMed

Verstappen SMM (2015) Rheumatoid arthritis and work: the impact of rheumatoid arthritis on absenteeism and presenteeism. Best Pract Res Clin Rheumatol 29(3):495–511. https://doi.org/10.1016/j.berh.2015.06.001CrossRefPubMed

Merkesdal S, Ruof J, Huelsemann JL, Mittendorf T, Handelmann S, Mau W, Zeidler H (2005) 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 53(2):234–240CrossRef

Braakman-Jansen LMA, Taal E, Kuper IH, van de Laar MAFJ (2012) Productivity loss due to absenteeism and presenteeism by different instruments in patients with RA and subjects without RA. Rheumatology (Oxford) 51(2):354–e61. https://doi.org/10.1093/rheumatology/ker371CrossRef

Huscher D, Mittendorf T, von Hinüber U, Kӧtter I, Hoese G, Pfӓfflin A, Bischoff S, Zink A, Centres GCA (2015) Evolution of cost structures in rheumatoid arthritis over the past decade. Ann Rheum Dis 74(4):738–745. https://doi.org/10.1136/annrheumdis-2013-204311CrossRefPubMed

Lenssinck MLB, Burdorf A, Boonen A, Gignac MA, Hazes JMW, Luime JJ (2013) Consequences of inflammatory arthritis for workplace productivity loss and sick leave: a systematic review. Ann Rheum Dis 72(4):493–505. https://doi.org/10.1136/annrheumdis-2012-201998CrossRefPubMed

10.

van der Zee-Neuen A, Putrik P, Ramiro S, Keszei AP, Hmamouchi I, Dougados M, Boonen A (2017) Large country differences in work outcomes in patients with RA – an analysis in the multinational study COMORA. Arthritis Res Ther 19(1):216. https://doi.org/10.1186/s13075-017-1421-yCrossRefPubMedPubMedCentral

11.

Krüger K, Wollenhaupt J, Lorenz HM, Rӧther E, Wittig BM (2012) Reduction in sickness absence in patients with rheumatoid arthritis receiving adalimumab: data from a German noninterventional study. Rheumatol Int 32(12):3977–3983. https://doi.org/10.1007/s00296-011-2317-9CrossRefPubMed

12.

Hussain W, Janoudi N, Noorwali A, Omran N, Baamer M, Assiry EH et al (2015) Effect of adalimumab on work ability assessed in rheumatoid arthritis disease patients in Saudi Arabia (AWARDS). Open Rheumatol J 9:46–50. https://doi.org/10.2174/1874312901409010046CrossRefPubMedPubMedCentral

13.

Zirkzee EJM, Sneep AC, de Buck PDM, Allaart CF, Peeters AJ, Ronday HK, Westedt ML, le Cessie S, Vliet Vlieland TPM (2008) Sick leave and work disability in patients with early arthritis. Clin Rheumatol 27(1):11–19. https://doi.org/10.1007/s10067-007-0642-xCrossRefPubMed

14.

Emery P, Smolen JS, Ganguli A, Meerwein S, Bao Y, Kupper H, Chen N, Kavanaugh A (2016) Effect of adalimumab on work-related outcomes scores in patients with early rheumatoid arthritis receiving methotrexate. Rheumatology (Oxford) 55(8):1458–1465. https://doi.org/10.1093/rheumatology/kew056CrossRef

15.

Takeuchi T, Nakajima R, Komatsu S, Yamazaki K, Nakamura T, Agata N, Igarashi A, Tango T, Tanaka Y (2017) Impact of adalimumab on work productivity and activity impairment in Japanese patients with rheumatoid arthritis: large-scale, prospective, single-cohort ANOUVEAU study. Adv Ther 34(3):686–702. https://doi.org/10.1007/s12325-017-0477-zCrossRefPubMedPubMedCentral

16.

Eriksson JK, Wallman JK, Miller H, Petersson IF, Ernestam S, Vivar N, van Vollenhoven RF, Neovius M (2016) Infliximab versus conventional combination treatment and seven-year work loss in early rheumatoid arthritis: results of a randomized Swedish trial. Arthritis Care Res 68(12):1758–1766. https://doi.org/10.1002/acr.22899CrossRef

17.

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. https://doi.org/10.1186/ar3141

18.

Reilly Associates (2002) WPAI scoring. http://www.reillyassociates.net/WPAI_Scoring.html. Accessed 8 July 2019

19.

Prevoo ML, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL (1995) 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 38(1):44–48CrossRef

20.

Bruce B, Fries JF (2005) The health assessment questionnaire (HAQ). Clin Exp Rheumatol 23(Suppl 39):S14–S18PubMed

21.

Federal Statistical Office (Destatis) (2017) Quality of employment. Dimension 2: income and indirect benefits from employment. Staff on sick leave

22.

Marschall J, Hildebrandt S, Sydow H, Nolting HD (2017) Gesundheitsreport 2017. medhochzwei Verlag, Heidelberg

23.

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 (2010) Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA study. Arthritis Res Ther 12(2):R24. https://doi.org/10.1186/ar2951CrossRef

24.

Søgaard R, Sørensen J, Linde L, Hetland ML (2010) The significance of presenteeism for the value of lost production: the case of rheumatoid arthritis. Clinicoecon Outcomes Res 2:105–112CrossRef

25.

Noben C, Vilsteren MV, Boot C, Steenbeek R, Schaardenburg DV, Anema JR, Evers S, Nijhuis F, Rijk A (2017) Economic evaluation of an intervention program with the aim to improve at-work productivity for workers with rheumatoid arthritis. J Occup Health 59(3):267–279. https://doi.org/10.1539/joh.16-0082-OACrossRefPubMedPubMedCentral

26.

Scharbatke EC, Behrens F, Schmalzing M, Koehm M, Greger G, Gnann H, Burkhardt H, Tony HP (2016) Association of improvement in pain with therapeutic response as determined by individual improvement criteria in patients with rheumatoid arthritis. Arthritis Care Res 68(11):1607–1615. https://doi.org/10.1002/acr.22884CrossRef

27.

Smolen JS, Strand V, Koenig AS, Szumski A, Kotak S, Jones TV (2016) Discordance between patient and physician assessments of global disease activity in rheumatoid arthritis and association with work productivity. Arthritis Res Ther 18(1):114. https://doi.org/10.1186/s13075-016-1004-3CrossRefPubMedPubMedCentral

28.

Aletaha D, Alasti F, Smolen JS (2015) Chronicity of rheumatoid arthritis affects the responsiveness of physical function, but not of disease activity measures in rheumatoid arthritis clinical trials. Ann Rheum Dis 74(3):532–537. https://doi.org/10.1136/annrheumdis-2013-204015CrossRefPubMed

29.

Martikainen JA, Kautiainen H, Rantalaiho V, Puolakka KT (2016) 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 43(12):2012–2015. https://doi.org/10.3899/jrheum.160103CrossRef

30.

Olofsson T, Söderling JK, Gülfe A, Kristensen LE, Wallman JK (2018) Patient-reported outcomes are more important than objective inflammatory markers for sick leave in biologics-treated patients with rheumatoid arthritis. Arthritis Care Res 70(11):1712–1716. https://doi.org/10.1002/acr.23619CrossRef

31.

Mattila K, Buttgereit F, Tuominen R (2014) Impact of morning stiffness on working behaviour and performance in people with rheumatoid arthritis. Rheumatol Int 34(12):1751–1758. https://doi.org/10.1007/s00296-014-3040-0CrossRefPubMedPubMedCentral

32.

Mattila K, Buttgereit F, Tuominen R (2015) Influence of rheumatoid arthritis-related morning stiffness on productivity at work: results from a survey in 11 European countries. Rheumatol Int 35(11):1791–1797. https://doi.org/10.1007/s00296-015-3275-4CrossRefPubMed

33.

Callhoff J, Luque Ramos A, Zink A, Hoffman F, Albrecht K (2017) 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 44(6):766–772. https://doi.org/10.3899/jrheum.160966CrossRefPubMed

34.

Aaltonen KJ, Ylikylä S, Tuulikki Joensuu J, Isomäki P, Pirilä L, Kauppi M, Rannio T, Eklund K, Blom M, Nordström D (2017) Efficacy and effectiveness of tumour necrosis factor inhibitors in the treatment of rheumatoid arthritis in randomized controlled trials and routine clinical practice. Rheumatology (Oxford) 56(5):725–735. https://doi.org/10.1093/rheumatology/kew467CrossRef

35.

Vashisht P, Sayles H, Cannella AC, Mikuls TR, Michaud K (2016) Generalizability of patients with rheumatoid arthritis in biologic agent clinical trials. Arthritis Care Res 68(10):1478–1488. https://doi.org/10.1002/acr.22860CrossRef

Title: Sustained improvement in work outcomes in employed patients with rheumatoid arthritis during 2 years of adalimumab therapy: an observational cohort study
Authors: Frank Behrens
Hans-Peter Tony
Michaela Koehm
Eva C. Schwaneck
Holger Gnann
Gerd Greger
Harald Burkhardt
Marc Schmalzing
Publication date: 01-09-2020
Publisher: Springer International Publishing
Keywords: Adalimumab
Rheumatoid Arthritis
Published in: Clinical Rheumatology / Issue 9/2020
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-020-05038-y

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Objective

Method

Results

Conclusions

Trial registration

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objective

Method

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 9/2020

Cancer risks along the disease trajectory in antineutrophil cytoplasmic antibody associated vasculitis

Fetuin-A and thyroxin binding globulin predict rituximab response in rheumatoid arthritis patients with insufficient response to anti-TNFα

Retention rates and identification of factors associated with anti-TNFα, anti-IL17, and anti-IL12/23R agents discontinuation in psoriatic arthritis patients: results from a real-world clinical setting

Assessment of a high-avidity IgG ANAs for the diagnosis and activity prediction of systemic lupus erythematosus

Large vessel disease as a potentially treatable cause of devastating critical digital ischaemia in systemic sclerosis

Sclerochoroidal calcifications associated with early-onset calcium pyrophosphate deposition disease

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page