Bruze Gustaf Magnus, Frisell Thomas, Turesson Carl, Forsblad-d'Elia Helena, Soderling Jonas, Askling Johan, Neovius Martin
Clinical Epidemiology Division, Dept of Medicine, Karolinska Institutet, Stockholm, Sweden
Clinical Epidemiology Division, Dept of Medicine, Karolinska Institutet, Stockholm, Sweden.
RMD Open. 2025 Jan 29;11(1):e004936. doi: 10.1136/rmdopen-2024-004936.
To compare work loss after starting tumour necrosis factor inhibitors (TNFi), rituximab, abatacept or tocilizumab in patients with rheumatoid arthritis (RA).
We used data from the Swedish Rheumatology Quality Register to identify patients aged 19-62 years who were treated with TNFi (n=15 093), rituximab (n=2123), abatacept (n=1877) or tocilizumab (n=1720) between 2007 and 2020. Data on work loss (0-365 days per year) from sick leave and disability pension were retrieved from linkage to the Social Insurance Agency. Patients in the different treatment arms were balanced regarding baseline covariates using inverse probability weighting (IPTW).
Work loss increased for patients with RA until drug treatment initiation, reached a peak in the month after treatment initiation and then levelled off. Following IPTW, at 3 years before starting the treatment, there were no statistically significant differences in the mean annual adjusted work loss days between rituximab, abatacept or tocilizumab vs TNFi (mean difference vs 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). At 3 years after starting the treatment (latest January 2021), there were also no statistically significant differences in the mean annual adjusted work loss days (mean difference: 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).
Taking channelling into account, patients with RA treated with TNFi, rituximab, abatacept or tocilizumab had similar trajectories of work loss from sick leave and disability pension until treatment initiation, and similar trend breaks and plateau 3 years thereafter.
比较类风湿关节炎（RA）患者开始使用肿瘤坏死因子抑制剂（TNFi）、利妥昔单抗、阿巴西普或托珠单抗后的工作损失情况。
我们使用瑞典风湿病质量登记处的数据，确定2007年至2020年间接受TNFi（n = 15093）、利妥昔单抗（n = 2123）、阿巴西普（n = 1877）或托珠单抗（n = 1720）治疗的19至62岁患者。通过与社会保险机构的数据关联，获取病假和残疾抚恤金导致的工作损失数据（每年0 - 365天）。使用逆概率加权法（IPTW）使不同治疗组的患者在基线协变量方面达到平衡。
RA患者的工作损失在开始药物治疗前增加，在治疗开始后的第一个月达到峰值，然后趋于平稳。经过IPTW后，在开始治疗前3年，利妥昔单抗、阿巴西普或托珠单抗与TNFi相比，平均每年调整后的工作损失天数无统计学显著差异（与TNFi的平均差异：利妥昔单抗1.1天，95%CI -4.5至6.7；阿巴西普3.3天，95%CI -2.6至9.2；托珠单抗1.2天，95%CI -4.9至7.3）。在开始治疗后3年（截至2021年1月），平均每年调整后的工作损失天数也无统计学显著差异（平均差异：利妥昔单抗 -4.8天，95%CI -11.3至1.7；阿巴西普5.3天，95%CI -1.8至12.3；托珠单抗 -0.6天，95%CI -7.7至6.5）。
考虑到治疗渠道因素，接受TNFi、利妥昔单抗、阿巴西普或托珠单抗治疗的RA患者在开始治疗前因病假和残疾抚恤金导致的工作损失轨迹相似，且在之后3年有相似的趋势变化和平稳期。
