Objectives To compare the effect of anti-TNF therapy (a-TNF-th) on Work Disability (WD) between RA, PSA and AS. In the Czech Republic (CZ), a-TNF-th is reimbursed for RA if DAS28>5.1 despite therapy with csDMARDs, for PSA if disease is not “adequately controlled” with csDMARDs, and for AS if BASDAI>4 and CRP/ESR elevated above normal. More than 95% of anti-TNF treated patients in CZ are followed up in the ATTRA registry.
Methods Bionäive patients with RA (n=1085), AS (n=1126) and PSA (n=351) starting a-TNF-th with available baseline data on demography, disease duration and physical function, and on working status at baseline and at 12 months were included in the analysis. Patients older than 60 years, on maternity leave or students were excluded. Work status was self-reported by patients as (A) able to work = [(i) employed, or (ii) unemployed and actively seeking employment], or (B) unable to work = [(iii) on sick leave, or (iv) on disability pension]. Regression analyses were performed to examine the predictors of improvement in WD (change B→A coded as 1, B→A as -1, no change as 0) over 1 year.
Results Baseline characteristic were significantly different between diagnoses (Table 1). In patients with RA, 60% were able to work at baseline and 61% at 12 month, with PSA 71% and 74% resp., and with AS 72% and 77% resp. The main driver of improvement of WD was a change in the sick leave (RA 6%→2%, PSA 7%→1%, AS 9%→2%). In univariate analyses, diagnosis of AS and younger age at start of a-TNF-th were predictive of improvement in WD. In multivariate analysis, only diagnosis of AS was significantly associated with improvement in WD.
Conclusions These real life data from CZ show that for improvement of WD, a-TNF-th was most effective in patients with AS. This may be a sequel of disease specific factors or reimbursement policy.
Disclosure of Interest None declared