Background Work disability is an important functional outcome among patients with chronic inflammatory diseases such as ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Maintenance of patients in the work force and return to employment are important treatment outcomes with implications for both patients and the healthcare system.
Objectives The aim of this analysis is to describe the prevalence of unemployment due to disability at baseline and to identify factors associated with work productivity loss in patients with AS and PsA followed in Canadian routine clinical care.
Methods Patients eligible for the COMPLETE studies were anti-TNFα naïve adults, with active AS or PsA per the judgment of the treating physician, who required change in their treatment regimen. This interim analysis included patients that were treated with adalimumab or non-biologic DMARDs and, were either employed or on disability at baseline. Work productivity was measured by the Work Limitations Questionnaire (WLQ). Depression was defined as a Beck’s Depression Inventory (BDI) score ≥20 and/or treatment with an antidepressant/anxiolytic at baseline. Multivariate generalized linear models were used to identify determinants of% WLQ productivity loss (WLQ-PL) scores at 6 and 12 months of treatment, along with the respective changes from baseline. Least Square Means (LSM) for the WLQ-PL improvement were reported from the multivariate model.
Results A total of 486 AS patients and 292 PsA patients were included in the analysis. The mean (SD) disease duration was 5.2 (8.6) and 12.8 (12.1) years, mean (SD) age was 41.7 (11.6) and 48.3 (10.5) years, and male predominance was 58.4% and 54.5%, in the AS and PsA groups, respectively. At baseline, 13.4% of AS patients and 17.8% of PsA patients were unemployed due to disability.
Among employed patients, the mean (SD) WLQ-PL score at baseline was 9.2% (5.7) in the AS patient group and 8.3% (6.0) in the PsA patient group. After 6 months of treatment significant improvement was observed in both patient populations (ΔAS [95% CI]: -2.7% [-3.4,-2.0]; ΔPsA [95% CI]: -2.1% [-2.9,-1.3]) which was maintained until 12 months.
Among AS patients, after adjusting for baseline parameters including age, sex, tobacco use, HLA B27 status, treatment group, depression, and baseline scores for BASFI and WLQ-PL using multivariate analysis, presence of depression (LSM: -0.2% vs. -2.5%; p=0.016) and female sex (LSM: -0.7% vs. -2.0%; p=0.047) were identified as significant negative predictors of improvement in work productivity at 6 months, while increased baseline work productivity was a positive predictor of improvement. In the PsA group, other than higher baseline work productivity (positive predictor of improvement), no significant predictors were identified at 6 months. However, a negative trend was observed for the presence of depression (LSM: -0.4% vs. -2.5%; p=0.068).
Conclusion We observed a significant proportion of AS and PsA patients unemployed in this real-world Canadian cohort. Treatment with adalimumab or non-biologic DMARDs was associated with significant improvement in work productivity irrespective of potential risk factors. Presence of depression was identified as an independent negative predictor of improvement in work performance/productivity.
Acknowledgement The authors wish to acknowledge JSS Medical Research for statistical analysis, medical writing and editorial assistance during the preparation of this abstract.
Disclosure of Interests Louis Bessette Grant/research support from: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Consultant for: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Speakers bureau: Amgen, BMS, Janssen, Roche, UCB, AbbVie, Pfizer, Merck, Celgene, Sanofi, Lilly, Novartis, Valencia P. Remple Shareholder of: AbbVie, Employee of: AbbVie, Samuel Silverberg Consultant for: AbbVie, Janssen, Viktoria Pavlova Grant/research support from: UCB, Consultant for: Amgen, Abbvie, BMS, Janssen, Lilly, Merk, Novartis, Roche, UCB, Pfizer, Speakers bureau: Amgen, Abbvie, BMS, Janssen, Lilly, Merk, Novartis, Roche, UCB, Pfizer, Majed Khraishi Consultant for: AbbVie, Speakers bureau: AbbVie
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