Newer RA drugs no better than old in keeping patients at work
But early, aggressive treatment does halt trend in increasing time off
Tuesday, 02 July 2013
People with rheumatoid arthritis whose disease has not responded well to methotrexate have no less time off work when taking a biological agent than those using conventional treatment, research has shown. But the authors of the study, published in JAMA Internal Medicine, point out that early, aggressive treatment does partly reverse the trend in taking increasing time off.
Researchers in Sweden recruited 204 people with RA in whom disease activity was not low despite 3-4 months’ methotrexate therapy. They assigned participants to either additional biological treatment with infliximab (105 patients) or to conventional combination treatment with sulfasalazine plus hydroxychloroquine (99 patients). They followed them for 21 months, recording monthly sick leave and disability pension days.
After this period, biological treatment was superior in terms of radiological changes. But this did not translate to a statistically significant difference in the amount of work lost. At the beginning of the study, the mean work loss in both groups had been 17 days per month – at 21 months, people in the infliximab group were losing 4.9 fewer work days per month on average than they had been losing at baseline, and those in the conventional treatment group were losing 6.2 days fewer.
The study’s authors said: “Our analysis showed that early and aggressive treatment in methotrexate-resistant patients not only stops the trend of increasing work loss days, as in patients with mainly established RA, but partly reverses it.
“However, we did not find any difference between treatment arms, indicating that the significantly improved disease control associated with infliximab treatment over a one-year period and the better radiological results after two years did not translate into less work loss.”
They concluded: “The substantially higher cost of infliximab relative to conventional treatment needs to be weighed against the greater incidence of short-term adverse events leading to discontinuation of conventional treatment.”