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Biological therapy and conventional treatment for rheumatoid arthritis equal for work loss

(RxWiki News) Rheumatoid arthritis can cause severe pain and stiff joints that make it hard for some patients to do their jobs. In fact, this disease is estimated to be responsible for a yearly cost of $11 billion due to work days lost.

A new study suggests that a relatively newer and more expensive treatment may not be much better than conventional therapy when it comes to keeping rheumatoid arthritis patients on the job.

Results of this study showed that a biological agent used for treatment of rheumatoid arthritis reduced the number of days of work lost, but so did conventional therapy.

"Ask a rheumatologist about new treatments for your arthritis."

This study was conducted by Jonas K. Eriksson, MSc, of the Karolinska Institutet in Sweden, and colleagues in order to examine the effectiveness of a new biological agent for rheumatoid arthritis.

This disease, which occurs when a person's joint tissue becomes inflamed and is destroyed by the body's own immune system, is usually treated first with a medication called methotrexate.

If a patient does not respond to methotrexate, they are then treated with a combination of sulfasalazine (brand name Azulfidine) and hydroxychloroquine (brand name Plaquenil).

Recently, biological agents such as infliximab (brand name Remicade), which block an inflammation-causing protein called tumor necrosis factor (TNF), have been used to treat patients who don’t respond to methotrexate.

This study aimed to find out if these anti-TNF medications, which can be expensive ($19,000 to $22,000 per year), could lead to reduced work loss among patients with rheumatoid arthritis.

The researchers first treated a population of patients with methotrexate for three to four months. Of the 204 who did not respond, 105 received infliximab. The other 99 received the conventional treatment of sulfasalzine plus hydroxychloroquine.

Patients' monthly sick leave and disability pension days were measured to estimate work loss.

The average work loss was the same (17 days a month) in both groups at the beginning of the study. But after 21 months of therapy, the average work loss was lower than at the beginning of the study by 4.9 days per month among patients treated with the biological medications and by 6.2 days per month among those who received the conventional treatment.  

Thus, the researchers found that although previous studies had demonstrated that biological therapy was better in controlling rheumatoid arthritis, the better control did not translate into lower number of work days lost.

"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 [rheumatoid arthritis], but partly reverses it," the researchers wrote.

"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 wrote.

The negative side effects associated with conventional therapy sometimes lead patients to discontinue treatment. The researchers suggested that the higher cost of infliximab compared to conventional treatment must also be weighed against the higher risk of side effects with conventional treatment.

This study was published July 1 in the JAMA Internal Medicine.

The research was funded by the Swedish Rheumatism Association and Schering-Plough/Merck Sharp and Dohm, the company that makes infliximab.

One of the study authors reported receiving research support and honoraria from several pharmaceutical companies including Merck Sharp. Another author reported participating in pharma company advisory boards and research products sponsored by pharmaceutical companies, including Schering-Plough.

Review Date: 
July 2, 2013