Consistent evidence has demonstrated that treatment with biologic therapy significantly improves work productivity and activity impairment among patients with axial spondyloarthritis (axSpA), according to the results of an analysis from the British Society for Rheumatology Biologics Register in Axial Spondylitis (BSRBS-AS). Study findings were published in the Annals of the Rheumatic Diseases.

The investigators sought to quantify the benefits of work outcomes associated with initiating biologic therapy in patients with axSpA. The BSRBS-AS recruited biologic-naive patients who fulfilled Assessment of SpondyloArthritis International Society criteria for axSpA from 83 centers in Great Britain. Work outcomes, which were evaluated using the Work Productivity and Activity Impairment Index, were compared between patients who were beginning biologic therapy at the time of study recruitment and patients who did not. Propensity score matching was used to adjust the differences between the treatment groups. To calculate pooled estimates, results from the BSRBS-AS were combined with those of other studies in a meta-analysis.

Among 577 participants in the analysis who were employed, 27.9% were beginning biologic therapy at the time of recruitment. After propensity score adjustment, patients receiving biologic therapy experienced significantly greater improvements in presenteeism at 12-month follow-up compared with those in the nonbiologic therapy group (-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%). No significant difference was reported with respect to absenteeism (-1.5%; 95% CI, -8.0% to 4.9).

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Despite these improvements, however, the effect on work was still greater among the biologic-treated cohort at follow-up. In the meta-analysis that included 1109 participants across observational trials and studies, treatment with biologics was associated with significantly greater improvements in presenteeism, work impairment, and activity impairment, but there was no difference reported in the rate of absenteeism.

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The investigators concluded that consistent evidence exists across various study designs to demonstrate that treatment with biologic agents is associated with significant and meaningful improvements in work productivity and activity among individuals with axSpA. Even with the improvements reported with biologic therapy, however, the presence of axSpA still has a considerable effect on patients’ work. Future studies in axSpA should include the assessment of work outcomes as standard to guarantee a greater evidence base around pharmacologic and nonpharmacologic approaches to the improvement of work outcomes in patients with the condition.

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Shim J, Jones GT, Pathan EMI, Macfarlane GJ. 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 [published online August 3, 2018]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2018-213590