Background There is a paucity of comparative, real-world data that describe the relationship between choice of biologic therapy and patient-reported outcomes in RA.
Objectives To compare the level of impairment in work and daily activities among patients prescribed different biologics for the treatment of RA, and to assess changes in these outcomes associated with switching biologic medication.
Methods Patients reporting physician-diagnosed RA and biologic use completed an online survey in 2009 or 2010; all data were self-reported. Work productivity and activity impairment were assessed using the Work Productivity and Activity Impairment questionnaire, which measures impairment over the previous 7 days. Patients using a biologic for the treatment of RA were grouped by the mechanism of action of the drug (anti-TNF, abatacept, rituximab). Patients taking tocilizumab were excluded due to small sample size (n=6). Those reporting previous use of an anti-TNF and current use of a different biologic (anti-TNF or other) were considered to have switched therapies and were included in subgroup analyses. All comparisons used generalised linear models to adjust for patient characteristics.
Results There were 821 patients receiving a biologic in the sample; 348 were employed. There were no significant differences in percentage impairment of work and activity between users of abatacept and those using anti-TNFs. In contrast, users of rituximab showed significantly greater overall work impairment than users of abatacept (p<0.05; Table). In subgroup analyses of patients who had switched biologic medication (abatacept: n=55, 18 employed; anti-TNF: n=235, 95 employed; rituximab: n=26, 8 employed), those who had switched to abatacept reported less impairment while at work (presenteeism) than patients who had switched to anti-TNFs (25.4% vs 40.8% respectively, p<0.05), and less overall work impairment (27.9% vs 44.7% respectively, p<0.05). No differences were observed in comparisons of abatacept with rituximab. Absenteeism and impairment in non-work activities were similar across all groups (all p>0.10).
Conclusions This real-world study demonstrates that abatacept users have significantly less work impairment than those on rituximab, even after controlling for covariates. Patients who had switched from an anti-TNF to abatacept were less impaired than patients who had switched to another anti-TNF. Although these findings should be confirmed using larger sample sizes, these data suggest that there may be differences in productivity and activity participation depending on class of therapeutic agent and treatment pattern.
Disclosure of Interest L. Rosenblatt Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, J. Vietri Grant/research support from: Bristol-Myers Squibb, Employee of: Kantar Health, J. Chapnick Grant/research support from: Bristol-Myers Squibb, Employee of: Kantar Health