The effect of etanercept on work productivity in patients with early active rheumatoid arthritis: results from the COMET study

Objectives. To compare the impact of the combination of etanercept (ETN) and MTX with MTX alone on work productivity among MTX-naive 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 pound and 1555 pound, respectively. When additionally accounting for presenteeism, the total improvement could be as high as 42 (95% Cl 16, 69) fewer lost workdays representing a productivity gain of 2968 pound. 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.