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Meta-Analysis
. 2023 Nov 30;9(4):e003468.
doi: 10.1136/rmdopen-2023-003468.

Work productivity in patients with axial spondyloarthritis initiating biological or targeted synthetic disease-modifying antirheumatic drugs: a systematic literature review and meta-analysis

Martin Rudwaleit  1 , Michael F Mørup  2 , Brittany Humphries  3 , Noor-E Zannat  4 , Damon Willems  5 , Vanessa Taieb  6 , Annelies Boonen  7   8
Affiliations
Meta-Analysis

Work productivity in patients with axial spondyloarthritis initiating biological or targeted synthetic disease-modifying antirheumatic drugs: a systematic literature review and meta-analysis

Martin Rudwaleit et al. RMD Open. .

Abstract

Background: Axial spondyloarthritis (axSpA) can limit work participation. Our objective was to characterise productivity in patients with axSpA, including changes after 12-16 weeks of treatment with biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs).

Methods: A systematic literature review identified studies published from 1 January 2010 to 21 October 2021 reporting work productivity using the Work Productivity and Activity Impairment (WPAI) questionnaire in patients with axSpA initiating b/tsDMARDs. Baseline and Week 12-16 overall work productivity, absenteeism, presenteeism and activity impairment scores were used in a random-effects meta-analysis to calculate absolute mean change from baseline for each WPAI-domain.

Results: Eleven studies in patients with axSpA who received either placebo (n=727) or treatment with adalimumab, bimekizumab, etanercept, ixekizumab, secukinumab or tofacitinib (n=994) were included. In working patients initiating a b/tsDMARD, mean baseline overall work productivity impairment, absenteeism and presenteeism scores were 52.1% (N=7 studies), 11.0% and 48.8% (N=6 studies), respectively. At Week 12-16, the pooled mean change from baseline in overall work impairment for b/tsDMARDs or placebo was -21.6% and -12.3%. When results were extrapolated to 1 year, the potential annual reductions in cost of paid and unpaid productivity loss per patient ranged from €11 962.88 to €14 293.54.

Conclusions: Over 50% of employed patients with active axSpA experienced work impairment, primarily due to presenteeism. Overall work productivity improved at Weeks 12-16 to a greater extent for patients who received b/tsDMARDs than placebo. Work productivity loss was associated with a substantial cost burden, which was reduced with improvements in impairment.

Keywords: Antirheumatic Agents; Inflammation; Outcome Assessment, Health Care; Patient Reported Outcome Measures; Spondylitis, Ankylosing.

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Conflict of interest statement

Competing interests: MR: Consultant to UCB Pharma; Speakers bureau from AbbVie, Boehringer Ingelheim, Eli Lilly, Janssen, Novartis, Pfizer and UCB Pharma; consultant of AbbVie, Eli Lilly, Novartis and UCB Pharma. MFM: Employee of UCB Pharma. DW and VT: Employees and stockholders of UCB Pharma. BH and N-EZ: Employees of Cytel, which served as a consultant on the project (at the time of research). AB: Received departmental research grants from AbbVie and consulting fees or honorarium from Galapagos, Hy2Care and Novartis.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram for identifying studies reporting Work Productivity and Activity Impairment outcomes in axSpA at week 12 (±4 weeks). axSpA, axial spondyloarthritis; HRQoL, health-related quality of life; PDF, Portable Document Format; SLR, systematic literature review; WPAI, Work Productivity and Activity Impairment.
Figure 2
Figure 2
Meta-analysis of mean change in overall work impairment scores at Weeks 12–16 from baseline. (A) Treated with b/tsDMARDs and (B) placebo. b/tsDMARD, biological or targeted-synthetic disease-modifying antirheumatic drug; IL-17Ai, interleukin-17A inhibitor; IL-17Ai/17Fi, interleukin-17A/17F inhibitor; Q2W, every 2 weeks; Q4W, every 4 weeks; TNFi, tumour necrosis factor inhibitor.
Figure 3
Figure 3
Meta-analysis of mean change in absenteeism scores at Weeks 12–16 from baseline. (A) Treated with b/tsDMARDs and (B) placebo. b/tsDMARD, biological or targeted-synthetic disease-modifying antirheumatic drug; IL-17Ai, interleukin-17A inhibitor; IL-17Ai/17Fi, interleukin-17A/17F inhibitor; Q2W, every 2 weeks; Q4W, every 4 weeks; TNFi, tumour necrosis factor inhibitor.
Figure 4
Figure 4
Meta-analysis of mean change in presenteeism scores at Weeks 12–16 from baseline. (A) Treated with b/tsDMARDs and (B) Placebo. b/tsDMARD, biological or targeted-synthetic disease-modifying antirheumatic drug; IL-17Ai, interleukin-17A inhibitor; IL-17Ai/17Fi, interleukin-17A/17F inhibitor; Q2W, every 2 weeks; Q4W, every 4 weeks; TNFi, tumour necrosis factor inhibitor.
Figure 5
Figure 5
Meta-analysis of mean change in activity impairment scores at Weeks 12–16 from baseline. (A) Treated with b/tsDMARDs and (B) placebo. b/tsDMARD, biological or targeted-synthetic disease-modifying antirheumatic drug; IL-17Ai, interleukin-17A inhibitor; IL-17Ai/17Fi, interleukin-17A/17F inhibitor; Q2W, every 2 weeks; Q4W, every 4 weeks; TNFi, tumour necrosis factor inhibitor.
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