Ab0608 Work Ability in Patients With Rheumatoid Arthritis Treated With Abatacept, Rituximab, Tocilizumab or TNF Inhibitors: A Nationwide Direct Drug-to-Drug Comparison

Background: Rheumatoid arthritis (RA) is associated with high costs to both patients and society due to impaired work ability. Whereas many studies have investigated differences in response and retention between individual DMARDs, considerably fewer have investigated comparative effectiveness in terms of longer-term outcomes such as work ability, let alone on a national scale. Objectives: To compare work loss after start of TNFi, rituximab, abatacept, or tocilizumab in patients with RA. Methods: We used data from the Swedish Rheumatology Quality Register between 2007 and 2020 to identify patients aged 19-62y who initiated TNFi (n=15,093), rituximab (n=2123), abatacept (n=1877), or tocilizumab (n=1720). Data on work loss (0-365 days per year) from sick leave and disability pension were retrieved from the Social Insurance Agency. The different treatment arms were balanced regarding baseline covariates (e.g. previous work loss) using inverse probability of treatment weighting. Results: At 3 years before treatment start, there were no statistically significant differences in mean work loss days per year between rituximab, abatacept or tocilizumab versus TNFi (mean difference versus TNFi: rituximab 1.1 days, 95%CI -4.5 to 6.7; abatacept 3.3, 95%CI -2.6 to 9.2; tocilizumab 1.2, 95%CI -4.9 to 7.3; Figure 1). Average work loss increased for patients with RA until the start of drug treatment, reached a peak in the month after treatment start, and then levelled off. At 3 years after treatment start, there were no statistically significant differences in mean annual adjusted work loss days (mean difference versus TNFi: rituximab -4.8 days, 95%CI -11.3 to 1.7; abatacept 5.3, 95%CI -1.8 to 12.3; tocilizumab -0.6, 95%CI -7.7 to 6.5). Conclusion: Taking channeling to treatment into account, patients with RA treated with TNFi, rituximab, abatacept, or tocilizumab had similar trajectories of increasing work loss from sick leave and disability pension until treatment initiation, and plateau in work loss thereafter. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: Gustaf Bruze Agreements between Karolinska Institutet (with JA as PI) and Abbvie, BMS, Eli Lilly, Galapagos, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, mainly for the national safety monitoring of rheumatology immunomodulators in Sweden (ARTIS)., Thomas Frisell Agreements between Karolinska Institutet (with JA as PI) and Abbvie, BMS, Eli Lilly, Galapagos, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, mainly for the national safety monitoring of rheumatology immunomodulators in Sweden (ARTIS)., Carl Turesson Speaker fees from Abbvie, Bristol-Myers Squibb, Janssen, MSD, Pfizer, Roche and UCB., Consulting fees from Bristol Myers-Squibb and Roche., Research grants from Bristol Myers-Squibb and Roche., Helena Forsblad-d'Elia Consulting fees from Sandoz, Novartis and Abbvie., Unrestricted research grant from Novartis, Johan Askling Agreements between Karolinska Institutet (with JA as PI) and Abbvie, BMS, Eli Lilly, Galapagos, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, mainly for the national safety monitoring of rheumatology immunomodulators in Sweden (ARTIS)., Martin Neovius Paid speeches when acting as member of advisory board 2011-2016., Independent consultant for pharmaceutical companies before 2009., Agreements between Karolinska Institutet (with JA as PI) and Abbvie, BMS, Eli Lilly, Galapagos, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, mainly for the national safety monitoring of rheumatology immunomodulators in Sweden (ARTIS).