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. 2017 Jul;76(7):1245-1252.
doi: 10.1136/annrheumdis-2016-210239. Epub 2017 Jan 10.

Predictors of work disability after start of anti-TNF therapy in a national cohort of Swedish patients with rheumatoid arthritis: does early anti-TNF therapy bring patients back to work?

T Olofsson  1 , I F Petersson  2 , J K Eriksson  3 , M Englund  2 , J A Nilsson  1 , P Geborek  1 , L T H Jacobsson  4 , J Askling  3 , M Neovius  3 ; ARTIS Study Group
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Predictors of work disability after start of anti-TNF therapy in a national cohort of Swedish patients with rheumatoid arthritis: does early anti-TNF therapy bring patients back to work?

T Olofsson et al. Ann Rheum Dis. 2017 Jul.

Abstract

Objectives: To examine predictors of work ability gain and loss after anti-tumour necrosis factor (TNF) start, respectively, in working-age patients with rheumatoid arthritis (RA) with a special focus on disease duration.

Methods: Patients with RA, aged 19-62 years, starting their first TNF inhibitor 2006-2009 with full work ability (0 sick leave/disability pension days during 3 months before bio-start; n=1048) or no work ability (90 days; n=753) were identified in the Swedish biologics register (Anti-Rheumatic Treatment In Sweden, ARTIS) and sick leave/disability pension days retrieved from the Social Insurance Agency. Outcome was defined as work ability gain ≥50% for patients without work ability at bio-start and work ability loss ≥50% for patients with full work ability, and survival analyses conducted. Baseline predictors including disease duration, age, sex, education level, employment, Health Assessment Questionnaire, Disease Activity Score 28 and relevant comorbidities were estimated using Cox regression.

Results: During 3 years after anti-TNF start, the probability of regaining work ability for totally work-disabled patients was 35% for those with disease duration <5 years and 14% for disease duration ≥5 years (adjusted HR 2.1 (95% CI 1.4 to 3.2)). For patients with full work ability at bio-start, disease duration did not predict work ability loss. Baseline disability pension was also a strong predictor of work ability gain after treatment start.

Conclusions: A substantial proportion of work-disabled patients with RA who start anti-TNF therapy regain work ability. Those initiating treatment within 5 years of symptom onset have a more than doubled 3-year probability of regaining work ability compared with later treatment starts. This effect seems largely due to the impact of disease duration on disability pension status.

Keywords: Anti-TNF; DMARDs (biologic); Outcomes research; Rheumatoid Arthritis; Social work.

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Conflict of interest statement

Competing interests: JA has research agreements (mainly for commissioned safety monitoring in ARTIS) with UCB, Roche, Merck, Pfizer, Samsung, Lilly and Abbvie, and has received remuneration for an ad board organised by Lilly. JKE has participated in research projects fully or partly funded by Novo Nordisk and COMBINE Sweden and served as an external consultant to AbbVie. MN has participated in advisory boards for Pfizer (rheumatology) and Abbott (non-rheumatology) and in research projects fully or partly funded by Schering-Plough, AstraZeneca, Novo Nordisk, Pfizer and Roche (unrelated to the current work). LTHJ has received fees for speaking and consultancy from Pfizer, Novartis, Abbvie and Celgene. IFP has reported ownership of options in Ana Mar.

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