Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

H2607Country of Residence Affects the Ability of Patients with Rheumatoid Arthritis (RA) To Achieve a Favorable Employment Status.

van Vollenhoven2,  Ronald, Cifaldi1,  Mary, Boonen4,  Annelies, Roy1,  Sanjoy, Chen1,  Naijun, Strand3,  Vibeke

Abbott Laboratories, Abbott Park, IL
Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
Stanford University, Palo Alto, CA
University Hospital Maastricht, Maastricht, The Netherlands


Clinical trials are conducted in many countries with varying social systems; country of residence may influence access to employment, disability benefits, and attitudes toward missing work for patients (pts) enrolling in RA trials. We examined differences in pts' probabilities of achieving favorable employment status (FES) in the PREMIER Health Economic Companion Study (DE032), based on country of residence.


PREMIER was a 2-year, randomized controlled trial of adalimumab (ADA), methotrexate (MTX), and ADA+MTX in pts with early RA (<3 years). DE032 was conducted in parallel with PREMIER and collected work productivity data for a large subset of pts. Countries were included if they had >25 employed pts at baseline. FES was defined as retaining baseline employment or gaining employment during the trial. Multivariate logistic regression models were used to evaluate association between FES at the end of the study for pts in each country vs. the other countries as a group. Adjustments were made for age, sex, Health Assessment Questionnaire Disability Index (HAQ DI), total Sharp score (TSS), treatment, and time on treatment. Baseline work-related outcomes were compared by country, including self-reported employed/homemaker status, missed work, % unfit for work at home, hours of missed work, and work productivity measured on a visual analog scale.


Four countries enrolled >25 working pts at baseline: Germany, Australia, the United States (US), and Canada. Approximately half of the pts were employed at baseline in Germany and Canada vs. about two-thirds in Australia and the US. Pts in Germany tended to miss work more often and for more days than pts in other countries. Germany had fewer homemakers vs. other countries. Impacts of RA on performance at work and at home were similar across countries. Multivariate regressions comparing the odds ratios (ORs) for FES by country relative to all other countries showed that residing in the US (OR=2.3, p<0.0001) had an independent effect on FES. Age, male sex, HAQ DI, and TSS were predictors for FES. ADA+MTX vs. MTX alone was a predictor of FES in every country studied, whereas ADA monotherapy was not.

Independent Effect of Country of Residence on Favorable Employment Status

 Employed WorkersHomemakersFavorable Employment Status
 N% at Baseline% Missed Work% at Baseline% Unfit for WorkOR95% CIP-value
United States130683340552.31.5–3.4<0.0001


Employment status and % missing work, which are driven by health and social policies, differed more than performance at work or at home. Residents of the US were more likely to achieve favorable employment status, perhaps because of greater access to employment, a tendency for employees to miss less work, and greater financial pressure to return to remunerative employment. These results are important in consideration of transferability of data between countries. Patients who received ADA+MTX (vs. MTX) were more likely to achieve favorable employment status in all countries, regardless of health care and social system differences.

To cite this abstract, please use the following information:
van Vollenhoven, Ronald, Cifaldi, Mary, Boonen, Annelies, Roy, Sanjoy, Chen, Naijun, Strand, Vibeke; H2607Country of Residence Affects the Ability of Patients with Rheumatoid Arthritis (RA) To Achieve a Favorable Employment Status. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :65
DOI: 10.1002/art.27834

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