Rheumatoid arthritis patients who are treated with an expensive injectable drug are likely to miss just as much work as those treated with a cheaper conventional treatment, according to a new study published in JAMA Internal Medicine.
Swedish researchers found that treatment with infliximab, a biological agent sold under the brand name Remicade, was just as effective as conventional treatment in reducing work loss for rheumatoid arthritis (RA) patients who responded poorly to methotrexate.
Previous studies on patients with early RA have shown that biological treatment with a tumor necrosis factor (TNF) inhibitor such as infliximab, when taken in combination with methotrexate, was clinically superior to methotrexate alone in slowing progression of the disease.
“Our analysis showed that early and aggressive treatment in methotrexate-resistant patients not only stops the trend of increasing work loss days, as in patients with mainly established RA, but partly reverses it,” the study noted.
“However, we did not find any difference between treatment arms, indicating that the significantly improved disease control associated with infliximab treatment over a one-year period and the better radiological results after two years did not translate into less work loss.”
Loss of work by rheumatoid arthritis patients can be substantial. Without aggressive treatment, 10% of patients will stop working within a year of diagnosis and half will do so within a decade. Nearly 90% will stop working before a normal retirement age.
Researchers at the Karolinska Institute in Sweden measured monthly sick leave and disability pension days of about 200 patients. They were divided into two groups; one that received additional biological treatment with infliximab and the other group received conventional combination treatment with sulfasalazine plus hydroxychloroquine.
At the start of the study, the average number of work days missed each month was 17 days in both groups. After a year of treatment, the average number of work days lost had fallen to 13 per month in both groups. After 21 months of treatment, the average number of work days missed was 12 a month in the biological group and 10 days in the conventional treatment group.
“With respect to work loss, our results indicate that before starting biological therapy in methotrexate-resistant patients with early RA, other intensive treatment regimens may be considered,” the report said.
For either treatment to be successful, researchers said they must be initiated early in the course of the disease. While the introduction of biological agents enabled better control of disease activity, researchers said their substantially higher cost “needs to be weighed.”
In the U.S., Remicade can cost up to $22,000 a year per patient wholesale, according to Janssen Biotech, a subsidiary of Johnson & Johnson. The drug has been used to treat more than 1.8 million patients for rheumatoid arthritis and other inflammatory diseases. Remicade made over $7 billion in worldwide sales last year for J&J and other drug makers.
The Swedish study comes two weeks after a report published in the New England Journal of Medicine found that patients who took a three drug regimen using oral generic drugs saw just as much improvement in their symptoms as those who underwent a costlier biologic treatment using Enbrel, an injectable drug sold by Amgen (NASDAQ: AMGN).
The average annual cost of the three drug therapy was about $1,000, compared to about $25,000 per year for Enbrel.
A separate study presented at the annual meeting of the European League Against Rheumatism found that about half of patients with rheumatoid arthritis stop taking their medications within two years, often because the drugs lose their effectiveness.
Rheumatoid arthritis is an autoimmune disease that causes inflammation in the joints, resulting in swelling, stiffness, pain and reduced joint function. It affects about 1.5 million Americans and has been estimated to incur annual costs of $11 billion due to work loss.