Impact of biological therapy on work outcomes in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS) and meta-analysis

Joanna Shim; Gareth T Jones; Ejaz M I Pathan; Gary J Macfarlane

doi:10.1136/annrheumdis-2018-213590

Impact of biological therapy on work outcomes in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS) and meta-analysis

Joanna Shim, Gareth T Jones, Ejaz M I Pathan, Gary J Macfarlane^* (Corresponding Author)

^*Corresponding author for this work

Toronto Western Hospital

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Abstract

Objectives To quantify, among patients with axial spondyloarthritis (axSpA), the benefit on work outcomes associated with commencing biologic therapy.

Methods The British Society for Rheumatology Biologics Register in Axial Spondyloarthritis (BSRBR-AS) recruited patients meeting Assessment of SpondyloArthritis International Society criteria for axSpA naïve to biological therapy across 83 centres in Great Britain. Work outcomes (measured using the Work Productivity and Activity Impairment Index) were compared between those starting biological therapy at the time of recruitment and those not. Differences between treatment groups were adjusted using propensity score matching. Results from BSRBR-AS were combined with other studies in a meta-analysis to calculate pooled estimates.

Results Of the 577 participants in this analysis who were in employment, 27.9% were starting biological therapy at the time of recruitment. After propensity score adjustment, patients undergoing biological therapy, at 12-month follow-up, experienced significantly greater improvements (relative to non-biological therapy) in presenteeism (−9.4%, 95% CI −15.3% to –3.5%), overall work impairment (−13.9%, 95% CI −21.1% to –6.7%) and overall activity impairment (−19.2%, 95% CI −26.3% to –12.2%). There was no difference in absenteeism (−1.5%, 95% CI −8.0 to 4.9). Despite these improvements, impact on work was still greater in the biological treated cohort at follow-up.

In the meta-analysis including 1109 subjects across observational studies and trials, treatment with biological therapy was associated with significantly greater improvements in presenteeism, work impairment and activity impairment, but there was no difference in absenteeism.

Conclusions There is consistent evidence that treatment with biological therapy significantly improves work productivity and activity impairment in people with axSpA. However, there remain substantial unmet needs in relation to work.

Original language	English
Pages (from-to)	1578-1584
Number of pages	7
Journal	Annals of the Rheumatic Diseases
Volume	77
Issue number	11
Early online date	3 Aug 2018
DOIs	https://doi.org/10.1136/annrheumdis-2018-213590
Publication status	Published - 1 Nov 2018

Bibliographical note

Funding
The BSRBR-AS is funded by the British Society for Rheumatology who have received funding for this from Pfizer, AbbVie and UCB. These companies receive advance copies of manuscripts for comments. This work was conducted within the Arthritis Research UK/Medical Research Council Centre for Musculoskeletal Work and Health (Grant No: 20665)

Acknowledgements
We are grateful to the staff of the British Society for Rheumatology Biologics Register in Axial Spondyloarthritis register who are currently Claudia Zabke, Maureen Heddle, Nafeesa Nazlee and Barry Morris, and to the recruiting staff at the clinical centres, details of which are available at: https://www.abdn.ac.uk/iahs/research/epidemiology/spondyloarthritis.php#panel1011. We would like to thank Dr Atul Deodhar, Benjamin Hsu and Chenglong Han for providing additional data relating to one of the studies, to allow it be included in the meta-analysis.

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Impact of biological therapy on work outcomes in patients with axial spondyloarthritis
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Impact of biological therapy on work outcomes in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS) and meta-analysis. / Shim, Joanna; Jones, Gareth T; Pathan, Ejaz M I et al.
In: Annals of the Rheumatic Diseases, Vol. 77, No. 11, 01.11.2018, p. 1578-1584.

Research output: Contribution to journal › Article › peer-review

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title = "Impact of biological therapy on work outcomes in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS) and meta-analysis",

abstract = "Objectives To quantify, among patients with axial spondyloarthritis (axSpA), the benefit on work outcomes associated with commencing biologic therapy.Methods The British Society for Rheumatology Biologics Register in Axial Spondyloarthritis (BSRBR-AS) recruited patients meeting Assessment of SpondyloArthritis International Society criteria for axSpA na{\"i}ve to biological therapy across 83 centres in Great Britain. Work outcomes (measured using the Work Productivity and Activity Impairment Index) were compared between those starting biological therapy at the time of recruitment and those not. Differences between treatment groups were adjusted using propensity score matching. Results from BSRBR-AS were combined with other studies in a meta-analysis to calculate pooled estimates.Results Of the 577 participants in this analysis who were in employment, 27.9% were starting biological therapy at the time of recruitment. After propensity score adjustment, patients undergoing biological therapy, at 12-month follow-up, experienced significantly greater improvements (relative to non-biological therapy) in presenteeism (−9.4%, 95% CI −15.3% to –3.5%), overall work impairment (−13.9%, 95% CI −21.1% to –6.7%) and overall activity impairment (−19.2%, 95% CI −26.3% to –12.2%). There was no difference in absenteeism (−1.5%, 95% CI −8.0 to 4.9). Despite these improvements, impact on work was still greater in the biological treated cohort at follow-up.In the meta-analysis including 1109 subjects across observational studies and trials, treatment with biological therapy was associated with significantly greater improvements in presenteeism, work impairment and activity impairment, but there was no difference in absenteeism.Conclusions There is consistent evidence that treatment with biological therapy significantly improves work productivity and activity impairment in people with axSpA. However, there remain substantial unmet needs in relation to work.",

author = "Joanna Shim and Jones, {Gareth T} and Pathan, {Ejaz M I} and Macfarlane, {Gary J}",

note = "Funding The BSRBR-AS is funded by the British Society for Rheumatology who have received funding for this from Pfizer, AbbVie and UCB. These companies receive advance copies of manuscripts for comments. This work was conducted within the Arthritis Research UK/Medical Research Council Centre for Musculoskeletal Work and Health (Grant No: 20665) Acknowledgements We are grateful to the staff of the British Society for Rheumatology Biologics Register in Axial Spondyloarthritis register who are currently Claudia Zabke, Maureen Heddle, Nafeesa Nazlee and Barry Morris, and to the recruiting staff at the clinical centres, details of which are available at: https://www.abdn.ac.uk/iahs/research/epidemiology/spondyloarthritis.php#panel1011. We would like to thank Dr Atul Deodhar, Benjamin Hsu and Chenglong Han for providing additional data relating to one of the studies, to allow it be included in the meta-analysis.",

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AU - Jones, Gareth T

AU - Pathan, Ejaz M I

AU - Macfarlane, Gary J

N1 - Funding The BSRBR-AS is funded by the British Society for Rheumatology who have received funding for this from Pfizer, AbbVie and UCB. These companies receive advance copies of manuscripts for comments. This work was conducted within the Arthritis Research UK/Medical Research Council Centre for Musculoskeletal Work and Health (Grant No: 20665) Acknowledgements We are grateful to the staff of the British Society for Rheumatology Biologics Register in Axial Spondyloarthritis register who are currently Claudia Zabke, Maureen Heddle, Nafeesa Nazlee and Barry Morris, and to the recruiting staff at the clinical centres, details of which are available at: https://www.abdn.ac.uk/iahs/research/epidemiology/spondyloarthritis.php#panel1011. We would like to thank Dr Atul Deodhar, Benjamin Hsu and Chenglong Han for providing additional data relating to one of the studies, to allow it be included in the meta-analysis.

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N2 - Objectives To quantify, among patients with axial spondyloarthritis (axSpA), the benefit on work outcomes associated with commencing biologic therapy.Methods The British Society for Rheumatology Biologics Register in Axial Spondyloarthritis (BSRBR-AS) recruited patients meeting Assessment of SpondyloArthritis International Society criteria for axSpA naïve to biological therapy across 83 centres in Great Britain. Work outcomes (measured using the Work Productivity and Activity Impairment Index) were compared between those starting biological therapy at the time of recruitment and those not. Differences between treatment groups were adjusted using propensity score matching. Results from BSRBR-AS were combined with other studies in a meta-analysis to calculate pooled estimates.Results Of the 577 participants in this analysis who were in employment, 27.9% were starting biological therapy at the time of recruitment. After propensity score adjustment, patients undergoing biological therapy, at 12-month follow-up, experienced significantly greater improvements (relative to non-biological therapy) in presenteeism (−9.4%, 95% CI −15.3% to –3.5%), overall work impairment (−13.9%, 95% CI −21.1% to –6.7%) and overall activity impairment (−19.2%, 95% CI −26.3% to –12.2%). There was no difference in absenteeism (−1.5%, 95% CI −8.0 to 4.9). Despite these improvements, impact on work was still greater in the biological treated cohort at follow-up.In the meta-analysis including 1109 subjects across observational studies and trials, treatment with biological therapy was associated with significantly greater improvements in presenteeism, work impairment and activity impairment, but there was no difference in absenteeism.Conclusions There is consistent evidence that treatment with biological therapy significantly improves work productivity and activity impairment in people with axSpA. However, there remain substantial unmet needs in relation to work.

AB - Objectives To quantify, among patients with axial spondyloarthritis (axSpA), the benefit on work outcomes associated with commencing biologic therapy.Methods The British Society for Rheumatology Biologics Register in Axial Spondyloarthritis (BSRBR-AS) recruited patients meeting Assessment of SpondyloArthritis International Society criteria for axSpA naïve to biological therapy across 83 centres in Great Britain. Work outcomes (measured using the Work Productivity and Activity Impairment Index) were compared between those starting biological therapy at the time of recruitment and those not. Differences between treatment groups were adjusted using propensity score matching. Results from BSRBR-AS were combined with other studies in a meta-analysis to calculate pooled estimates.Results Of the 577 participants in this analysis who were in employment, 27.9% were starting biological therapy at the time of recruitment. After propensity score adjustment, patients undergoing biological therapy, at 12-month follow-up, experienced significantly greater improvements (relative to non-biological therapy) in presenteeism (−9.4%, 95% CI −15.3% to –3.5%), overall work impairment (−13.9%, 95% CI −21.1% to –6.7%) and overall activity impairment (−19.2%, 95% CI −26.3% to –12.2%). There was no difference in absenteeism (−1.5%, 95% CI −8.0 to 4.9). Despite these improvements, impact on work was still greater in the biological treated cohort at follow-up.In the meta-analysis including 1109 subjects across observational studies and trials, treatment with biological therapy was associated with significantly greater improvements in presenteeism, work impairment and activity impairment, but there was no difference in absenteeism.Conclusions There is consistent evidence that treatment with biological therapy significantly improves work productivity and activity impairment in people with axSpA. However, there remain substantial unmet needs in relation to work.

U2 - 10.1136/annrheumdis-2018-213590

DO - 10.1136/annrheumdis-2018-213590

M3 - Article

SN - 0003-4967

VL - 77

SP - 1578

EP - 1584

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

IS - 11

ER -

Impact of biological therapy on work outcomes in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS) and meta-analysis

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Gareth Jones

Gary Macfarlane

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Impact of biological therapy on work outcomes in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS) and meta-analysis

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Bibliographical note

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Gareth Jones

Gary Macfarlane

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