The effect of biological agents on work participation in rheumatoid arthritis patients: a systematic review

Abstract

This study reviewed the effect of biological agents on participation in paid work among patients with rheumatoid arthritis (RA). A systematic literature search was performed to identify published articles reporting the effect of biological agents on employment status, sick leave and/or presenteeism. The quality of included articles was assessed according to the guidelines as proposed by the Dutch Cochrane Centre. Narrative summaries were used to present the data separately for randomised controlled trials (RCTs) as well as controlled and uncontrolled cohort studies. 19 studies (six uncontrolled cohorts, seven controlled cohorts and six RCTs) were included, in which 11 259 patients were treated with biological agents. Employment status improved in four out of 13 studies, absence from work in all 10 studies and presenteeism in seven out of nine studies that reported this outcome. For absenteeism and presenteeism the statistical significance of change or difference was not always provided and results within studies were sometimes conflicting when using different time frames or alternative outcomes. The large heterogeneity in terms of population, design, analyses and most important in outcome measures limits interpretation of the data. RCTs as well as cohort studies showed positive results of biological agents on both absenteeism and presenteeism compared with other disease-modifying antirheumatic drugs (DMARD), continuing the failing DMARD, the general population or the situation before the start of biological agents. The effect on employment status was more conflicting, but 50% of studies that addressed patients with early methotrexate-naive RA showed a positive result on employment status.

Rheumatoid arthritis and work: The impact of rheumatoid arthritis on absenteeism and presenteeism

“…The studies exploring the effect of biologic therapy on employment status have produced conflicting results [17], which can partly be explained by differences in study design (i.e., randomised clinical trial (RCT), open-label extension RCT or observational cohort study), inclusion of patients with early or established disease, instrument used to measure employment status, when the assessment of employment status was measured (i.e., prior and after start biologic therapy, at biologic therapy commencement and during follow-up after biologic therapy), follow-up duration, recall period and selection of patient population. For example, in the British Society for Rheumatology (BSR) Biologics Register for RA in the UK (BSRBR-RA), an observational study including patients starting biologic therapy and a control group of patients on sDMARDs, employment status did not differ between patients with RA receiving biologic therapies compared with patients using sDMARDs [18].…”

Evolution of cost structures in rheumatoid arthritis over the past decade

“…Significant reductions in hospitalisation, outpatient physician care, nurse visits and physiotherapy were observed in Sweden between 2001 and 2010 in RA patients relative to the general population 11. A systematic review of 19 studies showed positive effects of biological agents on absenteeism and presenteeism 12. Since long-standing high disease activity, poor functional status and comorbidity are the main cost drivers in RA,13 14 the objective of this study was to analyse how recent changes in treatment and outcomes are reflected in resource utilisation and societal cost.…”

Relationship of the clinical characteristics of rheumatoid arthritis to work capacity and efficiency

“…При переходе к анализу влияния РА на производи-тельность труда пациентов, в той или иной степени сохра-нивших трудоспособность, необходимо напомнить, что су-ществует более полутора десятков инструментов для изуче-ния снижения производительности труда вследствие болез-ни [27], результаты которых мало сопоставимы [27,28]. В нашей работе мы использовали опросник WPAI и не изу-чали динамику производительности труда на фоне различ-ных схем терапии.…”