Anti-TNF drug helps RA patients stay on the job

NEW YORK (Reuters Health) - Patients with rheumatoid arthritis (RA) given early treatment with a drug that blocks an inflammation-producing protein are more likely to keep working and are more productive on the job, new research suggests.

In RA, the membrane lining the joints becomes inflamed, causing pain, stiffness, swelling, leading eventually to disability. About 20 percent of people with RA will lose their jobs in the first year of having the disease if they receive treatment with standard drugs, Dr. Victoria Bejarano of the University of Leeds in the UK and colleagues note in the journal Arthritis & Rheumatism.

"By the time the patients have good disease control, their work has suffered for a substantial period, which in many cases is unsustainable and may require long-term sick leave, job reassignment, or reduction of work commitments," they write.

Recently, medications that target the inflammation-promoting protein tumor-necrosis factor (TNF) have been shown to sharply slow RA progression. But these drugs are not commonly the first treatment RA patients receive, because they are costly and there is little information on their long-term safety.

To investigate whether the anti-TNF drug adalimumab (sold as Humira) might help RA patients keep their jobs, the researchers randomized 148 patients to receive the drug plus methotrexate, a standard RA treatment, or methotrexate only, for 56 weeks. All reported having some impairment in their ability to work, although all held jobs at the study's outset.

After 16 weeks, 20, or 27.4 percent, of the patients taking methotrexate alone had lost their job or reported "imminent job loss," compared to 12, or 16 percent, of patients on the two-drug combination. By 56 weeks, 39.7 percent of the methotrexate-only patients were out of work or about to be, while 18.7 percent of patients taking adalimumab plus methotrexate were.

The current study -- the first to look at an anti-TNF drug's effects on RA patients' ability to work as its primary goal, "supports the early use of anti-TNF therapy and suggests its cost efficacy," the researchers conclude.

Abbott Laboratories, which makes adalimumab, funded the study.

SOURCE: Arthritis & Rheumatism, October 15, 2008.