AB0364 THE EFFECT OF BIOLOGIC AND TARGETED SYNTHETIC DISEASE MODIFYING ANTI-RHEUMATIC DRUGS ON WORK PARTICIPATION IN LONGSTANDING RHEUMATOID ARTHRITIS: RESULTS FROM A SYSTEMATIC LITERATURE REVIEW

BackgroundWork participation (WP) is a top priority for people with RA and a determinant of patients’ quality of life. Therefore, assessing the effect of interventions on WP outcomes is important.ObjectivesTo review the effect of b/tsDMARDs on employment status (ES), sick leave (SL) and presenteeism in patients with longstanding RA.MethodsA systematic literature review up to October 2021 was conducted using the PICOT framework (Figure 1). Two researchers independently screened abstracts, then full texts were reviewed to determine eligibility. Data from eligible articles were extracted. Heterogeneity and insufficient reporting of data precluded meta-analysis.ResultsWe included 42 studies:16 randomized controlled trials (RCT) and 26 longitudinal observational studies (OBS). All studies were conducted with background therapy with csDMARDs; 33 (78%) in csDMARD-IR patients. RCTs provided short-term data only (≤24 weeks (w)) which have limited relevance for WP outcome domains such as ES1. OBS reported long-term data (≤ 5 years), albeit imposing challenges due to lack of random allocation to interventions and often lack of a comparator. Regarding ES, 6 RCTs and 4 OBS did not report significant differences in bDMARD-treated patients vs background csDMARDs. For SL (19 studies), 1 RCT showed that etanercept significantly reduced RA-related SL up to 12-16w; however, one OBS showed no such effect on the long-term. Conflicting results were obtained by 2 RCTs on baricitinib. Most compounds assessed in the 12 OBS without comparator reported improvement in SL up to 104w. For presenteeism (11 studies; Table 1), 4 RCTs showed that etanercept, golimumab, certolizumab pegol, baricitinib and peficitinib were superior to PBO+csDMARDs up to 12w. Two H2H studies assessing sarilumab and baricitinib vs adalimumab observed comparable presenteeism in all treatment arms at 12-16w.Table 1.Overview of presenteeism from RCTs and OBS with a comparator in csDMARD-IR patientsAuthorYearInstrumentRecall periodIntervention (I)¶Comparator (C)¶N employed/N totalEffect sizeFrom the articleComputed SMD (95% CI)Bae2013WPAI-GH7 dI: ETNC: csDMARDNR/197NR/103% improvement49.623.6-0.24 (-0.5; -0)Bingham2014Self-composed single item4 wI: GOLC: PBONR/395NR/197Mean Δ (SD)–2.4 (2.8)–0.7 (4.5)-Emery2017WPAI-RA7 dI: BARI 2mgI: BARI 4mgC: PBO88/22976/22790/228LSM Δ from BL (95% CI)−14 (−20 to −8)−16 (−22 to −11)−8 (−13 to −2)-Keystone 2017WPAI-RA7 dI: BARIC: PBO199/487206/488LSM Δ from BL (95% CI)-18 (-22, -15)-10 (-13, -6)-Kavanaugh 2009WPS-RA1 mI: CZP 200 mgI: CZP 400 mgC: PBO132/393139/39069/199NR-0.09 (-0.3; 0.1)-0.17 (-0.3; -0)Kavanaugh 2009WPS-RA1 mI: CZP 200 mgI: CZP 400 mgC: PBO101/24695/24649/127NR-0.11 (-0.3; 0.1)-0.11 (-0.3; 0.1)Strand2018WPS-RA1 mI: SARIC: ADA78/184185LSM Δ from BL (SE)-3.74 (0.5)-3.50 (0.5)-Kaeley2018WPAI-RA7 dI: ADA + MTX 7.5mgC: ADA + MTX 20mgNR/154NR/155NR0.20 (-0.03-0.4)Tanaka2021†WPAI7 dI: PEF100mg ± csDMARDsI: PEF150mg ± csDMARDsC: PBO60/10453/10250/102Mean Δ−12.2−18.73.6-Tanaka2021WPAI7 dI: PEF100mg ± MTXI. PEF150mg ± MTXC: PBO ± MTX83/174101/17499/170Mean Δ−11.6−16.9−2.7-Tanaka2018 & 2020*WPAI 7 daysI: TCZC: csDMARDs167/377160/347Mean Δ-17.7-17.2-*OBS WPAI, work productivity and activity index; WPS, work productivity survey; GH, global health; NR, not reported; LSM, least mean square; BL, baseline; CI, confidence interval; SE, standard error; SMD, standardized mean difference; d, days; w, weeks; m, month. ¶Added to background therapy with csDMARDs unless otherwise stated.ConclusionShort-term data from RCTs with background therapy with csDMARDs showed adding b/tsDMARDs was more effective than PBO in improving presenteeism. However, data on SL are conflicting and the positive results come from OBS without comparator. Future studies should consider existing guidance on the assessment of WP outcome domains to allow pooling and meta-analysis1.References[1]Boonen A, et al. Ann Rheum Dis. 2021;80:1116-23.Disclosure of InterestsAlessia Alunno: None declared, Mary Lucy Marques: None declared, Louise Falzon: None declared, Sofia Ramiro: None declared, Annelies Boonen Speakers bureau: Abbvie, Galapagos, Consultant of: Galapagos, Grant/research support from: Abbvie