학술논문
Impact of TNF inhibitor medication on working ability in axial spondyloarthritis: an observational national registry-based cohort study
Clinical science
Clinical science
Document Type
Clinical report
Author
Source
Rheumatology Advances in Practice. July 2023, Vol. 7 Issue 2
Subject
Language
English
ISSN
2514-1775
Abstract
Introduction AS and non-radiographic axial SpA (nr-axSpA) are inflammatory rheumatic diseases. These conditions initiate typically before the age of 40 years, and AS patients have been shown to have increased [...]
Objective: The aim was to investigate the effect of TNF inhibitor (TNFi) initiation on working ability and health-care resource utilization among axial SpA patients in a real-life setting. Methods: Patients with a clinical diagnosis of non-radiographic (nr-axSpA) or radiographic axial SpA initiating their first TNFi were identified from the National Register for Antirheumatic and Biologic Treatment in Finland. Sickness absences, including sick leave and disability pension, in- and outpatient days and rehabilitation rates, 1 year before and after initiating the medication were retrieved from national registries. Factors affecting result variables were studied using multivariate regression analysis. Results: Overall, 787 patients were identified. Rates of work disability days per year were 55.6 the year before treatment onset and 55.2 the year after, with significant differences between patient subgroups. The rate of sick leave decreased after starting TNFi treatment. However, the rate of disability pension continued to rise. Patients with a diagnosis of nr- axSpA experienced a decrease in overall work disability and, especially, fewer sick leaves. No sex differences were detected. Conclusion: TNFi interrupts the increase in work disabled days evident during the year before its initiation. However, the overall work disability remains high. Treating patients earlier in the nr-axSpA phase, regardless of sex, appears important in maintaining the ability to work. Lay Summary What does this mean for patients? Maintaining the ability of patients to work is a complex and challenging task that deserves special attention when treating people with chronic inflammatory diseases, such as ankylosing spondylitis and non-radiographic SpA (nr-axSpA). Work disability remains a problem among these patients despite the evolving treatment options. We investigated how a type of drug called a tumour necrosis factor inhibitor (TNFi) affects working ability in people with nr-axSpA in a real-life setting in Finland. We used data on patients and their treatment from a database called the National Register for Antirheumatic and Biologic Treatment in Finland. We compared data on sick leave, in- and outpatient days and rehabilitation 1 year before and after starting TNFi medication. Our results show that TNFi medication substantially reduces the amount of sick leave that patients need to take, especially for people with nr-axSpA. However, we found that the amount of disability pension claimed rises steadily despite patients starting TNFi medication. Taking these results together, we conclude that starting TNFi medication might interrupt the decline in the ability to work in nr-axSpA patients. However, effective ways of maintaining patients' ability to work are still needed. Keywords: work disability, TNF inhibitor, axial SpA, AS, non-radiographic axial SpA, register study
Objective: The aim was to investigate the effect of TNF inhibitor (TNFi) initiation on working ability and health-care resource utilization among axial SpA patients in a real-life setting. Methods: Patients with a clinical diagnosis of non-radiographic (nr-axSpA) or radiographic axial SpA initiating their first TNFi were identified from the National Register for Antirheumatic and Biologic Treatment in Finland. Sickness absences, including sick leave and disability pension, in- and outpatient days and rehabilitation rates, 1 year before and after initiating the medication were retrieved from national registries. Factors affecting result variables were studied using multivariate regression analysis. Results: Overall, 787 patients were identified. Rates of work disability days per year were 55.6 the year before treatment onset and 55.2 the year after, with significant differences between patient subgroups. The rate of sick leave decreased after starting TNFi treatment. However, the rate of disability pension continued to rise. Patients with a diagnosis of nr- axSpA experienced a decrease in overall work disability and, especially, fewer sick leaves. No sex differences were detected. Conclusion: TNFi interrupts the increase in work disabled days evident during the year before its initiation. However, the overall work disability remains high. Treating patients earlier in the nr-axSpA phase, regardless of sex, appears important in maintaining the ability to work. Lay Summary What does this mean for patients? Maintaining the ability of patients to work is a complex and challenging task that deserves special attention when treating people with chronic inflammatory diseases, such as ankylosing spondylitis and non-radiographic SpA (nr-axSpA). Work disability remains a problem among these patients despite the evolving treatment options. We investigated how a type of drug called a tumour necrosis factor inhibitor (TNFi) affects working ability in people with nr-axSpA in a real-life setting in Finland. We used data on patients and their treatment from a database called the National Register for Antirheumatic and Biologic Treatment in Finland. We compared data on sick leave, in- and outpatient days and rehabilitation 1 year before and after starting TNFi medication. Our results show that TNFi medication substantially reduces the amount of sick leave that patients need to take, especially for people with nr-axSpA. However, we found that the amount of disability pension claimed rises steadily despite patients starting TNFi medication. Taking these results together, we conclude that starting TNFi medication might interrupt the decline in the ability to work in nr-axSpA patients. However, effective ways of maintaining patients' ability to work are still needed. Keywords: work disability, TNF inhibitor, axial SpA, AS, non-radiographic axial SpA, register study