Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Relationship Between Radiographic Damage and Employment Over Time in Patients with Early Rheumatoid Arthritis (RA): Results From the PREMIER Health Economic Companion Study DE032
van Vollenhoven1, Ronald, Cifaldi2, Mary, Roy2, Sanjoy, Chen2, Naijun, Bergman3, Martin J.
The relationship between joint damage and outcomes in early RA is poorly characterized. We evaluated the relationship between radiographic progression and employment status in the PREMIER health-economic companion study DE032.
PREMIER was a 2-year, multi-center, randomized, double-blind trial of adalimumab (ADA), methotrexate (MTX), and ADA+MTX in patients with early RA (<3 years). The DE032 companion study collected pharmacoeconomic data on a large subset of participating patients. A multivariate logistic regression model was used to evaluate the association between baseline radiographic scores (modified total Sharp score [mTSS]) and baseline self-reported employment status, with adjustments for age, sex, and baseline Health Assessment Questionnaire (HAQ). A receiver-operating characteristic (ROC) analysis determined the baseline mTSS cut-off value to differentiate between employed vs. unemployed patients with an optimum balance between sensitivity and specificity. Generalized estimating equation (GEE) models were used to estimate the relationship between mTSS and employment status over time, controlling for age, sex and HAQ. At the end of the study, whether patients gained or retained their employment was compared for patients who were radiographic progressors (DmTSS>0) vs. those who were non-progressors (DmTSS<=0) within treatment groups.
At baseline, 55% of patients were employed, and patients with lesser mTSS scores were more likely to be employed. For each unit increase of the mTSS, patients had 1.2% decreased odds of being employed (p< 0.05) compared with those with a 1-point lesser score. An absolute mTSS of 14 was the cut-off value for being employed with the greatest sum of sensitivity (60%) and specificity (58%). Over 2 years, patients with greater mTSS progression were more likely to stay or become unemployed; a 1-point increase in mTSS was associated with 1.1% decreased odds of being employed (p<0.01). Further, patients with mTSS>14 were 40% more likely to be unemployed than patients with mTSS<=14. The ADA+MTX group was more likely to have unchanged or decreased mTSS (non-progressors) and retained or gained employment than the MTX group (29% vs. 11%, p<0.0001). Patients who were progressors and lost employment or stayed unemployed were less likely to be in the ADA+MTX group than the MTX group (19% vs. 29%; p<0.001).
Patients with early RA with lesser baseline mTSS were more likely to be employed than patients with greater mTSS. Over 2 years, the beneficial radiographic effect of combination therapy with ADA+MTX was associated with more favorable employment status.
To cite this abstract, please use the following information:
van Vollenhoven, Ronald, Cifaldi, Mary, Roy, Sanjoy, Chen, Naijun, Bergman, Martin J.; Relationship Between Radiographic Damage and Employment Over Time in Patients with Early Rheumatoid Arthritis (RA): Results From the PREMIER Health Economic Companion Study DE032 [abstract]. Arthritis Rheum 2009;60 Suppl 10 :66