Effect of adalimumab on the work-related outcomes scores in patients with early rheumatoid arthritis receiving methotrexate.
To evaluate the effects of adalimumab plus MTX (ADA + MTX) vs MTX monotherapy on work-related outcomes in early RA patients with elevated risk of employment loss.



A post hoc analysis at weeks 26 and 24 from the Optimal Protocol for Treatment Initiation with Methotrexate and Adalimumab (OPTIMA) and PRevention Of Work Disability (PROWD) trials, respectively, was conducted in MTX-naïve RA patients randomized to ADA + MTX or placebo (PBO) + MTX. Work instability was assessed using the RA-Work Instability Scale (RA-WIS) and work productivity was measured with the Work Productivity and Activity Impairment Questionnaire. Employed patients with a baseline RA-WIS score ⩾10, indicating medium to high risk for job loss, were included (OPTIMA, n = 320; PROWD, n = 124).



Patients receiving ADA + MTX in OPTIMA had significantly greater improvements in RA-WIS compared with PBO + MTX (mean change -7.22 vs -5.23, respectively). Significantly higher percentages of patients in the ADA + MTX group experienced improvements in one or more risk category (58 vs 47%) and ⩾5 (55 vs 43%), ⩾7 (47 vs 35%) and ⩾9 (42% vs 26%) points in their RA-WIS score. These trends were seen in PROWD but were not significant. In OPTIMA, patients receiving ADA + MTX showed significant changes in percentage points from baseline vs PBO + MTX in activity impairment, presenteeism and overall work impairment (-32.0 vs -23.7, -24.6 vs -17.1, -27.3 vs -18.3, respectively).



Among early RA patients with elevated risk of employment loss, ADA + MTX therapy was associated with a significant reduction in work instability vs PBO + MTX. Significantly greater percentages of patients receiving ADA + MTX therapy achieved clinically meaningful improvements in their RA-WIS scores.
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK p.emery@leeds.ac.uk.
Paul
P
Emery
Department of Medicine 3, Division of Rheumatology, Medical University of Vienna 2nd Department of Medicine, Hietzing Hospital, Vienna, Austria.
Josef S
JS
Smolen
Health Economics and Outcomes Research, AbbVie, North Chicago, IL, USA.
Arijit
A
Ganguli
Pharmaceutical Development, AbbVie Deutschland, Ludwigshafen, Germany.
Sebastian
S
Meerwein
Health Economics and Outcomes Research, AbbVie, North Chicago, IL, USA.
Yanjun
Y
Bao
Pharmaceutical Development, AbbVie Deutschland, Ludwigshafen, Germany.
Hartmut
H
Kupper
Health Economics and Outcomes Research, AbbVie, North Chicago, IL, USA.
Naijun
N
Chen
Division of Rheumatology, Department of Medicine, UC San Diego, La Jolla, CA, USA.
Arthur
A
Kavanaugh
D000041:Absenteeism; D000068879:Adalimumab / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004526:Efficiency / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D000069597:Presenteeism / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014478:Unemployment / Q000706:statistics & numerical data
D018501:Antirheumatic Agents; D000068879:Adalimumab; D008727:Methotrexate
adalimumab; rheumatoid arthritis; work instability