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23-07-2013 | Rheumatology | Article

Intensive therapy pays employment dividends in rheumatoid arthritis


Free abstract

medwireNews: Biologic-based combination therapy for patients with rheumatoid arthritis (RA) is no more effective in reducing work loss than conventional combination therapy, despite better radiologic outcomes, shows a secondary analysis of a randomized trial.

However, intensifying treatment in patients who had failed to respond to methotrexate alone did improve work outcomes among the 204 patients in the study, who had early RA (symptoms for <1 year), regardless of the drugs used.

“Although it is true that combinations including biological agents were no more effective in reducing sick or pension benefit days, both treatments reduced the number of days by about a quarter,” writes Edward Yelin (University of California, San Francisco, USA) in an editorial accompanying the study in JAMA Internal Medicine.

“Treating to a target of low disease progression does reduce the work effects of RA, whatever the treatment strategy. Given how refractory employment is to intervention, that is a positive impact indeed.”

During 21 months of follow up, patients who had infliximab added to their baseline methotrexate treatment had an average reduction of 4.9 days per month off work, from a baseline of 17 days off per month.

This was not significantly different from the average reduction of 6.2 days per month, also from a baseline of 17 days off per month, seen among the 99 patients who had sulfasalazine plus hydroxychloroquine added to their treatment. In a per protocol analysis, the difference between the two groups fell from an adjusted average difference of 1.6 days to just 0.3 days.

However, the original findings of the multicenter, randomized, open-label trial showed significantly better radiologic outcomes in patients assigned to receive infliximab, rather than conventional drugs, note study author Jonas Eriksson (Karolinska Institutet, Stockholm, Sweden) and co-workers.

Yelin observes: “The implication is that employment is determined by a complex set of factors, including the severity of disease but also extending to the individual’s demographic background, the nature of his or her work, and the general state of the economy.”

However, he says that, as biologic agents are generally approved for use only after failure of conventional drugs, “the true implication of the current findings may be that biological combination treatments may have an acceptable employment outcome” if started after conventional treatment has failed.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Eleanor McDermid, Senior medwireNews Reporter

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