Background The addition of biological agents in treatment strategies in chronic inflammatory arthritides have improved the possibility of controlling disease activity and slowing the progression of joint damage. However their impact on work participation is unclear.
Objectives To assess the effect of biological agents on participation in paid work among patients with chronic inflammatory arthritides.
Methods A systematic review of the literature using PUBMED, EMBASE and the Cochrane library was performed until November 2010. All randomized controlled trials (RCTs) reporting the effect of biological agents (TNF inhibitors, antiCD20 monoclonal antibody, CTLA4Ig, antiIL6, antiIL1) on work participation among patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) or psoriatic arthritis (PsA) were selected. Data extraction: Data were collected using a predetermined form. The outcomes were missed workdays (for a period of 100 days at work), productivity (on a visual analogue scale) and job loss. Statistical analysis determined in each RCT effect size (ES), standardized response mean (SRM) or odds-ratios (OR) as appropriate to assess the magnitude of treatment effect. Pooled ES, SRM and OR were computed by meta-analysis. A random effect model was used in case of heterogeneity.
Results 7 RCTs were analyzed i.e. 1115 patients treated by biological agents (adalimumab, etanercept, infliximab) and 779 controls.Among those 1894 patients, 1658 suffered from RA, 122 from AS, and 144 from PsA. Pooled analyses indicated that biological agents significantly reduced missed workdays (yes/no; 2 trials): OR=0.49 (95%CI 0.33 to 0.72), (continuous; 3 trials): SRM= -0.90 (95%CI -2.09 to 0.29) and improved work productivity (2 trials): ES=0.29 (95%CI 0.12 to 0.46). The positive effect on job loss was not significant (2 trials):OR=0.54 (95%CI 0.26 to 1.14).
Figure: the efficacy on missed work days (yes/no) of biological agents versus control
Conclusions Despite the scarcity and the heterogeneity of the data, this meta-analysis showed the beneficial effect of biologics agents on both absenteeism and presenteeism in chronic inflammatory rheumatism. Thus the high cost of biologic agents could be partly balanced with savings in indirect costs.
Disclosure of Interest None Declared