Effect of the early use of the anti–tumor necrosis factor adalimumab on the prevention of job loss in patients with early rheumatoid arthritis

Authors: Bejarano, V., Quinn, M., Conaghan, P. G., Reece, R., Keenan, A.-M., Walker, D., Gough, A., Green, M., McGonagle, D., Adebajo, A., Jarrett, S., Doherty, S., Hordon, L., Melsom, R., Unnebrink, K., Kupper, H., & Emery, P.
Year Published 2008
Publication Arthritis Care & Research
Volume 59
Number 10
Pages 1467-1474
Publisher American College of Rheumatology
Background The impact of rheumatoid arthritis (RA) on work disability and job loss represents a significant economic burden.  Recent developments in therapies targeted against tumor necrosis factor (TNF)have changed the approach to RA treatment by rapidly controlling the disease.
Purpose To compare work disability and job loss in early rheumatoid arthritis (RA) patients receiving adalimumab plus methotrexate (adalimumab + MTX) versus MTX alone.
Setting The setting included a variety of medical centers providing treatment for rheumatoid arthritis.
Sample In this multicenter, randomized, controlled trial, patients with RA for <2 years who had never taken MTX and who self-reported work impairment were randomized to adalimumab + MTX or placebo + MTX for 56 weeks.
Data Collection Primary outcome was job loss of any cause and/or imminent job loss at or after week 16. Secondary outcomes included disease activity, function (Health Assessment Questionnaire [HAQ] score), and RA quality of life (RAQoL) questionnaire score. Work was evaluated with work diaries and the RA Work Instability Scale.
Control The comparison was treatment using MTX alone.
Findings Although job loss during the 56-week study was significantly lower with adalimumab + MTX (14 of 75 patients) compared with MTX alone (29 of 73 patients; P = 0.005), the primary end point was not met (12 of 75 versus 20 of 73 patients; P = 0.092), likely owing to early drop out in the MTX group. There were significant improvements in American College of Rheumatology 20% response criteria, 28-joint Disease Activity Score, HAQ, RAQoL, and working time lost in the adalimumab + MTX group. Twenty-four serious adverse events were reported in 17 participants, with no differences between groups.
Conclusions Adalimumab + MTX reduced job loss and improved productivity in early RA when compared with MTX alone, which supports the early use of anti–tumor necrosis factor therapy and suggests its cost efficacy.
URL http://www.ncbi.nlm.nih.gov/pubmed/18821658
Disabilities
Populations Male & Female
Outcomes Full-time employment | Part-time employment
NIDILRR Funded No
Research Design Randomized Controlled Trials (RCTs)
Peer Reviewed Yes