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RESEARCH - The effect of Enbrel on work productivity in patients with early active RA: COMET

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Rheumatology Advance Access originally published online on August 18, 2009

Rheumatology 2009 48(10):1283-1289; doi:10.1093/rheumatology/kep239

The effect of etanercept on work productivity in patients with early

active rheumatoid arthritis: results from the COMET study

Aslam Anis1,2, Wei Zhang2, Emery3, Huiying Sun2, Amitabh Singh4,

Bruce Freundlich5 and Reiko Sato4

1School of Population and Public Health, University of British

Columbia, 2Centre for Health Evaluation and Outcome Sciences, St

's Hospital, Vancouver, Canada, 3Academic Unit of Musculoskeletal

Disease, Leeds University, Leeds, UK, 4Global Health Outcomes

Assessment and 5Global Medical Affairs, Wyeth, Collegeville, PA, USA.

Abstract

Objectives. To compare the impact of the combination of etanercept

(ETN) and MTX with MTX alone on work productivity among MTX-naïve

patients with active early RA over a 12-month period.

Methods. The COMET (COmbination of Methotrexate and ETanercept) trial

was a 2-year double-blind randomized clinical trial. Absenteeism

during the first year was measured and it included: (i) number of

missed workdays; (ii) reduced working time; and (iii) number of

stopped workdays. Each absenteeism measure was estimated using a mixed

model, and their variations were estimated by bootstrapping. As a

sensitivity analysis, the lost workdays due to presenteeism (reduced

performance at work) was also estimated.

Results. Two hundred and five patients [MTX (n = 100) vs ETN + MTX (n

= 105)], who were working full time or part time at baseline and had

at least one follow-up observation, were included in the analysis.

Compared with the MTX group, the ETN + MTX group had a maximum of 37

fewer missed workdays or at minimum 22 fewer missed workdays. The

associated productivity gain equalled £2586 and £1555, respectively.

When additionally accounting for presenteeism, the total improvement

could be as high as 42 (95% CI 16, 69) fewer lost workdays

representing a productivity gain of £2968.

Conclusions. Our results demonstrated that early treatment with ETN +

MTX led to a significant attenuation of absenteeism among patients

with early active RA. These productivity gains represent benefit

beyond the traditional measures of clinical and radiographic

improvements. Further research to simultaneously measure both

absenteeism and presenteeism is warranted.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/48/10/1283?etoc

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