DMARD Therapy Improves Work Capacity in Patients with PsA

Laure Gossec, MD, PhD

Credit: LinkedIn

A systematic literature review and meta-analysis demonstrated patients with active psoriatic arthritis (PsA) have a significantly reduced capacity to work and participate in leisure activities, according to a study published in Arthritis Research and Therapy.¹ However, significant improvements across Work Productivity and Activity Impairment Questionnaire (WPAI) domains were observed after 24 weeks of biologic and targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) treatment, particularly in presenteeism, activity impairment, and total work productivity.

PsA impacts health-related quality of life in patients and extends beyond joint damage to include comorbidities such as cardiovascular disease, depression, anxiety, and obesity. Patients often report their disease effects social participation, physiological functioning, and individual activities.²

“The consequences of PsA on work are important and include deleterious effects such as hours of missed work (absenteeism), diminished productivity while at work (presenteeism), and increased economic burden due to indirect costs,” wrote Laure Gossec, MD, PhD, professor of rheumatology at Sorbonne Université and Pitié-Salpêtrière Hospital, Paris, France, and colleagues.

To understand the course of work productivity and leisure activity in patients with PsA treated with b/tsDMARDs, investigators identified all eligible trials and observational studies related to work productivity and WPAI published between January 1, 2010, and October 22, 2021. Outcomes of interest in WPAI domains were total work productivity, absenteeism, presenteeism, and activity impairment. Data were collected at baseline and at the time point closest to 24 weeks post-treatment initiation. The overall absolute mean change from baseline for each WPAI domain was calculated using a random effects meta-analysis of single means.

A total of 12 studies, including 10 randomized controlled trials and 2 observational studies, evaluated patients treated with adalimumab, bimekizumab, ixekizumab, risankizumab, secukinumab, bimekizumab, and upadacitinib. Among patients who were employed (n = 3741), the overall mean baseline scores were 11.4% for absenteeism, 38.7% for presenteeism, 42.7% for total work productivity impairment, and 48.9% for activity impairment. The estimated absolute mean improvements to week 24 were 2.4 percentage points (0.6, 4.1), 17.8%p (16.2,19.3), 17.6%p (15.9,19.4), and 19.3%p (17.6, 21.0) respectively. These results led to a mean relative improvement of 41% for total work productivity. Changes in work outcomes among the b/tsDMARDs were comparable.

Investigators noted the sole use of WPAI as a limitation of the study. Although it is a common and validated measure of productivity, other questionnaires such as the Work Productivity Scale (WPS) and the Work Limitations Questionnaire (WLQ) could have also been useful in the analysis. However, focusing on WPAI alone helped to facilitate the comparability of the results and allowed researchers to perform a quantitative synthesis of findings.

An additional limitation was the variation of methods used to estimate the costs attributable to lost productivity due to PsA. Although the WPAI is concerned with absenteeism and presenteeism, other factors, such as early retirement due to PsA or those who were able to return to work after successful treatment, could not be determined. As patients with PsA treatment with a b/tsDMARDs generally have more severe disease activity, future research should include a broader PsA sample population.

“Measuring work impact should be considered an essential part of the overall assessment of the economic burden and the value assessment of therapies in PsA,” investigators concluded. “The results demonstrate that patients with PsA suffered from substantial total work productivity impairment but report meaningful improvement after 24 weeks of treatment with a b/tsDMARD. This provides payers and other decision-makers with valuable data to inform decisions about the cost-effectiveness of b/tsDMARDs in PsA.”

References

1. ^{Gossec L, Humphries B, Rutherford M, Taieb V, Willems D, Tillett W. Improvement in work productivity among psoriatic arthritis patients treated with biologic or targeted synthetic drugs: a systematic literature review and meta-analysis. Arthritis Res Ther. 2024;26(1):50. Published 2024 Feb 15. doi:10.1186/s13075-024-03282-0}
2. ^{Gudu T, Gossec L. Quality of life in psoriatic arthritis. Expert Rev Clin Immunol. 2018;14(5):405–17. https://doi.org/10.1080/1744666X.2018.1468252.}