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

ObjectivesTo quantify, among patients with axial spondyloarthritis (axSpA), the benefit on work outcomes associated with commencing biologic therapy.MethodsThe British Society for Rheumatology Biologics Register in Axial Spondyloarthritis (BSRBRAS) 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.ResultsOf 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.ConclusionsThere 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.

Amongst patients taking biologic therapies for axial spondyloarthritis, which factors are associated with work non-participation?

“…Observational data have only recently started to emerge. In the BSRBR-AS cohort [11], propensity matching was used to compare patients starting biologic therapy with those not starting such therapy. The authors found that patients undergoing biologic therapy experienced significantly greater improvements in presenteeism, work impairment and activity impairment than the untreated patients.…”

“…In this setting, absenteeism has been the most commonly evaluated outcome measure. A recent UK prospective cohort study identified that starting biologic therapy was associated with improvement in work outcomes compared to those not starting such therapy, but the negative impact on work was still substantial [11]. A few researchers have recently reported work participation in patients with early axSpA [12,13] and these have suggested some impact of the disease on work participation but do not provide any information about the impact of longstanding disease or whether outcomes can be improved by early, effective disease control.…”

Determining factors related to poor quality of life in patients with axial spondyloarthritis: results from the British Society for Rheumatology Biologics Register (BSRBR-AS)

“…axSpA has an impact on people’s working lives; mental health and physical health symptoms, such as pain and fatigue, have been shown to have an important influence on QoL 1 2. Further, we (and others) have shown that pharmacological therapy targeted at reducing disease activity in inflammatory arthritis may have modest effects on aspects such as mental health,3 fatigue4 and work productivity 5…”

Outcomes and treatment responses, including work productivity, among people with axial spondyloarthritis living in urban and rural areas: a mixed-methods study within a national register

“…improves functional capacity in axSpA, significant unmet need remains in terms of work disability. 8 There is good evidence that supportive work environments are important to enable individuals with health conditions to work; however, not all workplaces are created equally, and in particular there are important rural-urban differences. 9 While employment rates may be higher, incomes tend to be lower in rural areas, with restricted choice and opportunities for career advancement.…”