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Impact of adalimumab on work participation in rheumatoid arthritis: comparison of an open-label extension study and a registry-based control group
  1. Michael T. Halpern (carrie.bray{at}
  1. Emory University, United States
    1. Mary A. Cifaldi (mary.cifaldi{at}
    1. Abbott Laboratories, United States
      1. Tore K. Kvien (t.k.kvien{at}
      1. Diakonhjemmet Hospital, Norway


        Objectives: Rheumatoid arthritis (RA) causes significant disability and often results in loss of work capacity and productivity. We evaluated the impact of adalimumab, a tumour necrosis factor antagonist with demonstrated efficacy in RA, on long-term employment.

        Methods: Data from an open-label extension study (DE033) of 486 RA patients receiving adalimumab monotherapy who previously failed at least 1 disease-modifying antirheumatic drug (DMARD) and had baseline work status information were compared with data from 747 RA patients receiving DMARD therapy in a Norway-based longitudinal registry. Primary outcomes included the time patients continued working at least part-time and the likelihood of stopping work. Secondary outcomes included American College of Rheumatology (ACR) and EULAR responses and disease remission. Outcomes were compared 6, 12, and 24 months after enrollment.

        Results: During a 24-month period, the 158 adalimumab-treated patients who were working at baseline worked 7.32 months longer (95% confidence interval [CI]: 4.8, 9.1) than did the 180 DMARD-treated patients, controlling for differences in baseline characteristics. Regardless of baseline work status, patients receiving adalimumab worked 2.0 months longer (95% CI: 1.3, 2.6) and were significantly less likely to stop working (hazard ratio [HR], 0.36, 95% CI: –0.30, 0.42] for all patients and 0.36, 95% CI: 0.15, 0.85] for patients working at baseline, respectively) than those receiving DMARDs. Adalimumab-treated patients also were significantly more likely to achieve ACR responses and disease remission than DMARD-treated patients. Patients who achieved EULAR good response and remission were less likely to stop working, but this relationship was only seen in in patients receiving DMARDs.

        Conclusions: Patients with RA receiving adalimumab experienced significantly longer periods of work and continuous employment, as well as greater rates of clinical responses, than did those receiving DMARDs. The mechanism by which adalimumab decreases likelihood of stopping work appears different from that of DMARD therapy and independent of clinical responses.

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