Employment Is Maintained and Sick Days Decreased in Psoriasis/Psoriatic Arthritis Patients With Etanercept Treatment

Robert L Boggs; Sarolta Kárpáti; Wenzhi Li; Theresa Williams; Ronald Pedersen; Lotus Mallbris; Robert Gniadecki

BMC Dermatol. 2014;14(14)

Abstract and Introduction

Abstract

Background: Psoriasis and psoriatic arthritis (PsA) impair quality of life, including reduction in employment or job duties. The PRESTA (Psoriasis Randomized Etanercept STudy in Patients with Psoriatic Arthritis) study, a randomized, double-blind, two-dose trial, examined the efficacy of etanercept treatment in patients with moderate-to-severe plaque psoriasis and PsA and the main results have been presented previously. This analysis examined employment status, job duties and sick days, pre-defined endpoints in PRESTA, among this patient population.

Methods: Participants (N = 752) were randomized to receive etanercept 50 mg twice weekly (BIW; n = 379) or 50 mg once weekly (QW; n = 373) for 12 weeks by subcutaneous injection. All participants then received open-label etanercept 50 mg QW for 12 additional weeks, while remaining blinded to the randomization. A pharmacoeconomic questionnaire was administered at baseline, week 12 and week 24 of treatment. The questionnaire included employment status and changing job responsibilities and sick time taken due to psoriasis or PsA. The statistical methods included analysis of covariance, t-test, Fisher's exact test and McNemar's test. Last-observation-carried-forward imputation was used for missing data.

Results: Employment was at least maintained from baseline to week 24 in both dose groups (56% [BIW/QW] and 60% [QW/QW] at baseline, 61% and 60%, respectively, at week 24). Among employed participants, the proportion of patients whose job responsibilities changed due to PsA decreased significantly from baseline to week 24 (17–23% to 5–8%; p < 0.01). Similar results were seen with job responsibility changes due to psoriasis (11–14% to 4%; p < 0.01). The number of monthly sick days also decreased from baseline to week 24 (2.4 days for both treatment groups to 0.7 (BIW/QW) and 1.1 (QW/QW); p ≤ 0.03 for each). No significant differences between the treatment groups were observed for any economic endpoint at any time point.

Conclusions: For patients with moderate-to-severe plaque psoriasis and PsA, etanercept treatment resulted in reducing job responsibility changes due to disease and in reducing sick time. Effective treatment of psoriasis and PsA may reduce missed work days.

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Abstract and Introduction
Background
Methods
Results
Discussion
Conclusions
References

Table 1. Baseline demographics and clinical characteristics for employed vs. not employed patients (patient subpopulation <65 years old)
	Employed (n = 431)	Not employed (n = 276)	Total (n = 707)
Age, years	43.6 (9.4)*	47.4 (10.9)	45.1 (10.2)
Gender, male, n (%)	321 (74.5)^†	133 (48.2)	454 (64.2)
Race, White, n (%)	386 (89.6)	238 (86.2)	624 (88.3)
Body mass index	27.7 (5.2)	28.3 (5.9)	28.0 (5.5)
Psoriasis disease duration, years	18.0 (10.2)	19.1 (12.6)	18.4 (11.2)
PsA disease duration, years	6.7 (6.7)	7.5 (7.5)	7.0 (7.0)
Physician Psoriasis Assessment (scale: 0–5; higher scores = worse psoriasis)	3.6 (0.6)*	3.7 (0.7)	3.6 (0.7)
PASI (scale: 0–72; higher scores = worse psoriasis)	18.5 (9.5)*	21.4 (11.1)	19.6 (10.3)
BSA affected, %	28.7 (21.4)*	34.7 (23.6)	31.0 (22.5)
PGA of arthritis (scale: 0–100; higher scores = worse arthritis)	48.9 (20.4)*	53.2 (21.5)	50.6 (20.9)
Swollen joints (0–68)	11.4 (13.9)*	14.5 (16.8)	12.6 (15.2)
Tender joints (0–72)	17.6 (16.8)*	22.0 (19.1)	19.4 (17.9)
DLQI, total (scale: 0–30; higher scores = worse dermatology-related quality of life)	11.6 (7.3)*	13.8 (7.7)	12.5 (7.3)
EQ-5D Utility (scale: 0–1; higher scores = better quality of life), mean	0.55 (0.28)*	0.38 (0.35)	0.48 (0.32)
EQ-5D VAS (scale: 1–100; higher scores = better health), mean	58.0 (20.7)*	51.9 (20.6)	55.6 (20.9)
HAQ DI (scale: 0–3; higher scores = more disability), mean	0.72 (0.59)*	1.20 (0.75)	0.91 (0.69)

*p < 0.01, for employed vs. not employed, one-way analysis of variance; ^†p < 0.01, for employed vs. not employed, Fisher's Exact Test p-value (2-tail).
Mean (SD), unless otherwise noted.

Table 2. Predictive ability of baseline characteristics on employment outcomes
Independent variables (X variables used as predictors)	Dependent variables (Y variable being predicted)
	Employed		Job responsibility change due to psoriasis		Job responsibility change due to PsA		Sick days
	Week 12	Week 24	Week 12	Week 24	Week 12	Week 24	Week 12	Week 24
Age	NS	NS	1.05 (1.00, 1.11)	NS	NS	1.04 (1.00, 1.09)	NS	NS
Female	NS	NS	3.1 (1.1, 9.0)	NS	NS	NS	NS	NS
Duration of psoriasis	NS	NS	NS	NS	NS	NS	NS	NS
Duration of PsA	NS	NS	NS	NS	NS	NS	NS	NS
ETN BIW/QW	5.2 (1.7, 15.7)	3.0 (1.1, 8.0)	NS	NS	NS	NS	NS	NS
Baseline job change due to psoriasis	NS	NS	22.9 (7.9, 66.3)	10.9 (4.0, 29.9)	3.1 (1.2, 8.6)	NS	2.6 (1.4, 3.8)	3.4 (1.8, 5.0)
Baseline job change due to PsA	NS	NS	NS	NS	4.9 (1.8, 12.9)	6.3 (2.7, 14.6)	NS	-1.7 (-3.0, -0.4)
Baseline sick days*	NS	0.94 (0.90, 0.99)	NS	NS	NS	NS	0.17 (0.11, 0.24)	0.15 (0.08, 0.22)
Baseline hours worked^†	1.05 (1.02, 1.08)	NS	NS	0.96 (0.93, 0.99)	0.96 (0.94, 0.98)	0.95 (0.92, 0.97)	-0.04 (-0.06, -0.01)	-0.04 (-0.07, -0.01)

NS = Not significant.
Data for all dependent variables are odds ratio (95% confidence intervals) except Sick days which show slope (95% confidence intervals). *Odds are for a one-day increase in baseline sick days. ^†Odds are for a one-hour increase in baseline hours worked.