Search

Background: Work disability remains a significant problem in ankylosing spondylitis (AS) and rheumatoid arthritis (RA), despite biological therapy. This study aimed to test the hypothesis that the prevalent symptom of fatigue longitudinally predicts work disability among RA and AS patients commencing etanercept., Methods: Two observational studies, comprising RA and AS etanercept commencers, respectively, were analysed. Both provided data on work disability over 1 year and a comprehensive set of putative predictors, including fatigue. A series of repeated measures models were conducted, including baseline variables, visit (6/12 months), and the interaction between visit and each of the explanatory variables., Results: A total of 1003 AS and 1747 RA patients were assessed. For AS, fatigue was significantly associated with presenteeism (linear mixed model coefficient 3.75, 95% confidence interval (CI) 2.14 to 5.36) and activity impairment (2.62, 1.26 to 3.98), but not with work productivity loss (1.81, -0.40 to 4.02) or absenteeism (generalised linear mixed model odds ratio (OR) 1.18, 95% CI 0.92 to 1.51). In RA, fatigue was associated with presenteeism (coefficient 3.44, 95% CI 2.17 to 4.70), activity impairment (1.52, 0.79 to 2.26), work productivity loss (4.16, 2.47 to 5.85), and absenteeism (OR 1.23, 95% CI 1.02 to 1.49). The lack of significant interactions between fatigue and visit supported a consistent effect of baseline fatigue over time., Conclusions: Among patients beginning etanercept therapy, fatigue has a significant and independent effect on absenteeism, presenteeism, productivity loss, and activity impairment for RA patients and a significant but dimension-selective effect on work disability among AS patients., Trial Registration: ClinicalTrials.gov, NCT00544557 . Registered on 16 October 2007. ClinicalTrials.gov, NCT00488475 . Registered on 20 June 2006.

Background: Patient-reported outcomes in psoriasis studies are assessed at specific study time points. If a treatment has not become effective by a certain time point, it may increase the likelihood of patients being dissatisfied and leaving a clinical study., Objectives: To generate evidence concerning the number of patients dropping out of etanercept trials over time including Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) data., Methods: Data from patients with psoriasis in 10 trials with etanercept were pooled. Analyses were performed for (i) patients who dropped out because of 'lack of efficacy' and (ii) patients who continued the trial. The PASI and DLQI data were summarized for different time points. The distribution of dropout over time, PASI, DLQI and the proportion of patients dropping out with given treatment responses were calculated., Results: Of 6119 patients, 128 dropped out because of lack of efficacy (or synonym). The highest increase of patients dropping out happened between day 75 and 85 (cumulative percentage rise from 46% to 73%). The lowest PASI of patients dropping out was 6·3 within 120 days. Individuals who dropped out who achieved ≥ PASI 75 (at least a 75% improvement from baseline PASI) were rare., Conclusions: A critical time when many patients might have lost their willingness to wait for their treatment with etanercept to show a better effect appeared to be at around day 80. Most of the patients dropping out showed little improvement, stable disease or worsening of their psoriasis., (© 2017 British Association of Dermatologists.)