Background Improved productivity has been observed for rheumatoid arthritis (RA) patients achieving a good response with anti-TNF therapy. We hypothesized that the magnitude of improvement in patient-level resource use indicators may be affected by the degree of treatment response.
Objectives To evaluate resource use, engagement in activities of daily living (ADLs), and employment status by level of disease activity in anti-TNF therapy in RA.
Methods The Alberta Biologics Pharmacosurveillance Program evaluates the longitudinal clinical efficacy and safety of anti-TNF therapy for RA. Patients report every 6 months on their resource use (hospital services, community services, out-of-pocket costs), ADLs, and changes in employment status. We compared differences in resource use reported in the first year of treatment between patients achieving any definition of remission (2011 ACR/EULAR Boolean definition, SDAI ≤3.3, CDAI ≤2.8, DAS28 ≤2.6), minimal disease activity (DAS28 <2.85, SDAI <11 or CDAI <10) or remaining in moderate or high disease activity.
Results A total of 1,777 patients (70% female, disease duration 12 years, median DMARD exposure 3) initiated a new biologic therapy between April 2004 and March 2010. Baseline disease activity scores were: HAQ 1.15 (SD 0.76), DAS28 4.36 (SD 1.90), tender joint count 7.1 (SD 8.2), swollen joint count 4.7 (SD 5.5), and patient global 4.6 (SD 2.8). Over the first year of biologic therapy, 556 individuals met remission criteria (31%), and an additional 393 (22%) met minimal disease activity criteria, with the remainder remaining in moderate or high disease activity. Patients attaining remission, relative to those remaining in moderate or high disease activity, had significant improvements in resource utilization, engagement in ADLs and work productivity (Table 1). Patients only achieving minimal disease activity had similar resource use, impairments in activities of daily living and employment status compared to patients in moderate or high disease activity.
Conclusions Patients achieving remission, relative to patients remaining in minimal, moderate or high disease activity, have significant reductions in resource use, have increased engagement in activities of daily living, and improved productivity. Treatment goals advocating remission over minimal disease activity are encouraged.
Disclosure of Interest None Declared
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