FRI0106 Impact of biological and targeted synthetic dmards on work in patients with chronic inflammatory arthritis : a meta analysis of randomised controlled trials and controlled cohorts
Authors: C. Traverson, A. tubery, C. Hua, F. Barchechath-Flaisler, C. Lukas, B. Combe, J. Morel, C. Gaujoux-Viala
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The addition of biological (b) and new targeted synthetic (ts) DMARDs agents in chronic inflammatory arthritis (CIAs) therapeutic strategies has improved the possibility of controlling disease activity and slowing the progression of joint damage. However their impact on work participation is unclear. <h3>Objectives</h3> To assess the effect of biological and tsDMARDs versus conventional treatments in patients with CIAs on work outcomes : employment, presenteeism and absenteeism. <h3>Methods</h3> A systematic review of the literature using Pubmed-Medline and the Cochrane library was performed until January 2017. All randomised controlled trials (RCT) and controlled cohorts (CC) comparing work outcomes in patients with rheumatic diseases such as rheumatic arthritis (RA), ankylosing spondylarthris (AS) and psoriatic arthritis (PsA) treated with biological or tsDMARDs versus conventional therapies were selected. Statistical analysis determined in each study effect size (ES) or odds-ratios (OR) as appropriate to assess the magnitude of treatment effect. Pooled ES and OR were computed by meta-analysis. A random effect model was used in case of heterogeneity. <h3>Results</h3> Thirty six RCTs and eight CCs were analysed ie 12 769 patients with conventional treatment and 19 875 patients with bDMARD or tsDMARD (4619 Infliximab, 4629 Etanercept, 3872 Adalimumab, 670 Golimumab, 2101 Certolizumab, 691 Abatacept, 444 Sirukumab, 1668 Baricitinib, 672 Tofacitinib, 365 Sarilumab, 444 Sirukumab etc); 34 studies included 30 423 patients with RA, 7 studies included 1496 patients with AS and 3 studies included 725 patients with PsA. This meta-analysis showed in patients treated by bDMARD vs conventional treatment: - a significant decrease of accumulated missed workdays at week 24: ES −0.34 IC95%[−0.6; −0.08] and at week 52: ES −0.04 IC95% [–0.29; 0.2], - a significant decrease of patients loosing hours due to CIAs: RR 0.63 IC95%[0.48; 0.83], - a significant improvement in VAS productivity: ES −1.81 IC95%[−2.61; −1.01], - For the employment loss, the positive effect of bDMARDs was nearly significant: OR 0.60 IC95% [0.33; 1.09]. <h3>Conclusions</h3> Despite the heterogeneity of the data, this meta-analysis showed the beneficial effect of bDMARDs on both absenteeism and presenteeism in CIAs. Thus the high cost of biologic agents could be partly balanced with savings in indirect costs. <h3>Disclosure of Interest</h3> C. Traverson: None declared, A. tubery: None declared, C. Hua Consultant for: Pfizer, BMS, abbvie, F. Barchechath-Flaisler Consultant for: Roche Pharmaceuticals, C. Lukas Consultant for: Abbvie, BMS, Celgene, Janssen, MSD, Novartis, Pfizer, Sanofi, Schering, Roche- Chugai, UCB, B. Combe Grant/research support from: Pfizer, UCB, Consultant for: Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, UCB, Speakers bureau: BMS, Janssen, Lilly, MSD, Pfizer, Roche-Chugai, UCB, J. Morel Consultant for: Abbvie, BMS, Celgene, Janssen, Medac, MSD, Novartis, Pfizer, Sanofi, Schering, Roche- Chugai, UCB, C. Gaujoux-Viala Grant/research support from: Pfizer, Consultant for: Abbvie, BMS, Celgene, Janssen, Medac, MSD, Nordic Pharma, Novartis, Pfizer, Sanofi, Roche- Chugai, UCB