Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Ann Rheum Dis. 2012 Dec;71(12):1924-33. doi: 10.1136/annrheumdis-2012-201914. Epub 2012 Sep 6.
To review systematically the effect of biological treatment in patients with ankylosing spondylitis (AS) on three work outcomes: work status, absence from paid work and at-work productivity.
A systematic literature search was performed (Pubmed, Embase, Cochrane Library) to identify relevant articles. Risk of bias of included studies was assessed using the Cochrane guidelines for cohorts and randomised controlled trials (RCTs). Data were extracted using a self-composed data extraction form. Owing to extensive interstudy heterogeneity, narrative summaries were used to present the data.
Nine studies were included (six uncontrolled cohorts, one population-controlled cohort and two RCTs) that reported on 39 comparisons. Overall, 961 patients were treated with three different tumour necrosis factor α inhibitors (etanercept, infliximab, adalimumab). For presenteeism and absence from work, most comparisons showed improvement in favour of biological agents, but not all comparisons were statistically significant and they usually concerned before-after analyses. For work status, changes were less often positive, but studies dealt with patients with longstanding AS, lacked power and had a relatively short follow-up.
Although trends towards beneficial effects of biological agents in longstanding AS were seen on all work outcomes, the methodological limitations in the studies included hampers clear conclusions. Since the majority of studies were (extensions of) controlled trials, the generalisability of the effect of biological agents on work participation in real life should be further studied in larger (population-controlled) studies. The effect of biological agents in patients with early disease has not yet been examined.
系统回顾生物治疗对强直性脊柱炎（AS）患者的三项工作结果的影响：工作状态、带薪缺勤和工作生产力。
进行了系统的文献检索（Pubmed、Embase、Cochrane 图书馆）以确定相关文章。使用 Cochrane 指南对纳入研究的队列和随机对照试验（RCT）进行偏倚风险评估。使用自行编制的数据提取表提取数据。由于研究间存在广泛的异质性，采用叙述性总结来呈现数据。
纳入了 9 项研究（6 项非对照队列研究、1 项人群对照队列研究和 2 项 RCT），报告了 39 项比较。总体而言，有 961 名患者接受了三种不同的肿瘤坏死因子 α 抑制剂（依那西普、英夫利昔单抗、阿达木单抗）治疗。对于出勤和缺勤，大多数比较都显示出生物制剂的改善，但并非所有比较均具有统计学意义，且通常涉及前后分析。对于工作状态，变化并不总是积极的，但研究涉及到患有长期 AS 的患者，缺乏效力，且随访时间相对较短。
尽管在所有工作结果上，长期 AS 患者使用生物制剂都显示出有益的趋势，但纳入研究的方法学局限性限制了明确的结论。由于大多数研究都是对照试验的扩展，因此应在更大的（人群对照）研究中进一步研究生物制剂对现实生活中工作参与的影响的普遍性。生物制剂在早期疾病患者中的作用尚未得到检验。
