This article is more than 5 years old. Information may no longer be current.
Biologics no more effective than DMARDs in reducing work loss among RA patients
Early rheumatoid arthritis patients who showed poor response to methotrexate and underwent biological tumor necrosis factor therapy did not experience better work loss outcomes than patients assigned conventional disease-modifying antirheumatic drugs in a recent study.
Investigators studied 204 early rheumatoid arthritis (RA) patients (disease duration less than 1 year), who were recruited from 15 rheumatology clinics in Sweden from Oct. 1, 2002 through Dec. 21, 2005. All patients were of working class, aged younger than 63 years and had low disease activity response after 3 or 4 months of methotrexate therapy.
Patients were randomly assigned 3 mg/kg infliximab (n=105) intravenously at baseline and at weeks 2 and 6 and every 8 weeks up until 21 months, or combination disease-modifying antirheumatic drugs (DMARDs) that included 1,000 mg sulfasalazine (n=99) twice daily plus 400 mg hydroxychloroquine daily. Primary outcome was to determine whether biologics — which displayed superior radiological outcomes than DMARDs — would result in reduced time away from work attributed to sick days or disability pension. Monthly sick leave and disability pension information was gathered after randomization from the Swedish Social Insurance Office register.
Mean work loss at baseline was 17 days monthly in both groups (mean difference, 0.6 days/month; 95% CI, –3 to 3.9). At 21 months, mean work loss was 12 d/mo (mean change, –4.9 d/mo) in the biologics group vs. 10 d/mo (mean change, –6.2 d/mo) among DMARD patients (adjusted mean difference, 1.6 d/mo; 95% CI, –1.2 to 4.4).
“Treatment including a biological agent was not superior to conventional treatment in terms of effect on work loss over a 21-month period in patients with early RA with methotrexate treatment failure,” the researchers concluded. “Although a substantial improvement in work loss was achieved in both arms, the persisting gap relative to the general population indicates a need for more effective treatment strategies and earlier diagnosis of RA.”