The Effect of Biologic and Targeted Synthetic Drugs on Work- and Productivity-related Outcomes for Patients with Psoriatic Arthritis: A Systematic Review

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
Figure 1.
Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flow diagram. RCT: randomized controlled trial; DMARD: disease-modifying antirheumatic drug.

Table 1.

Characteristics of included studies.

Study, Yr	Treatment	Outcome Measurement Time, wks	Biologic-experienced Patients, %	Group Size	Age, Mean	Female, %	HAQ-DI, Mean (SD)	DAS28, Mean (SD)	PASI, Mean (SD)	Patients Employed, %
Kavanaugh, et al, 2006¹⁰	PBO	14	0	100	47	49	1.1 (0.6)	NR	10.2 (9.0)	66.7
Kavanaugh, et al, 2006¹⁰	IFX, 5 mg/kg	14	0	100	46.5	29	1.1 (0.6)	NR	11.4 (12.7)	73
Kavanaugh, et al, 2009¹¹	PBO	24	0	113	47	39	1 (0.5)	4.85 (1.02)	8.4 (7.4)	NR
	GOL, 50 mg	24	0	146	45.7	39	1 (0.6)	4.96 (1.10)	9.8 (8.6)	NR
	GOL, 100 mg	24	0	146	48.2	41	1.1 (0.6)	4.89 (1.06)	11.1 (9.5)	NR
Kavanaugh, et al, 2012¹²	PBO	24	0	206	47.4	47.6	1.3 (0.74)	5.2 (4.4–6.0)^*	8.8 (7.3)	NR
	UST, 45 mg	24	0	205	47.1	48.3	1.3 (0.74)	5.2 (4.6–5.7)^*	7.1 (8.9)	NR
	UST, 90 mg	24	0	204	46.8	43.1	1.3 (0.59)	5.2 (4.6–5.8)^*	8.4 (7.3)	NR
Kavanaugh, et al, 2015¹³	PBO	24	19.1	136	47.3	58.1	1.3 (0.7)	NR	7.1	56.6
	CZP, 200 mg	24	22.5	138	48.2	53.6	1.3 (0.7)	NR	7	60.1
	CZP, 400 mg	24	17	135	47.1	54.1	1.3 (0.6)	NR	8.1	61.5
Zhang, et al, 2014¹⁴	PBO	16	24.4	168	51.1	47.6	1.2 (0.6)	4.9 (1.0)	9.1 (9.5)	NR
	APR, 20 mg	16	22	168	48.7	49.4	1.2 (0.6)	4.8 (1.1)	7.4 (8.7)	NR
	APR, 30 mg	16	24.4	168	51.4	54.7	1.2 (0.6)	4.9 (1.0)	9.2 (9.7)	NR

↵* Median (IQR). IFX: infliximab; PBO: placebo; GOL: golimumab; UST: ustekinumab; CZP: certolizumab pegol; APR: apremilast; HAQ-DI: Health Assessment Questionnaire–Disability Index; DAS28: 28-joint Disease Activity Score; PASI: Psoriasis Area Severity Index; IQR: interquartile range; NR: not reported.

Table 2.

Cochrane Risk of Bias assessment.

Study, Yr	Random Sequence Generation		Allocation Concealment		Blinding of Participants and Personnel		Blinding of Outcome Assessment		Incomplete Outcome Data		Selective Reporting		Other Sources of Bias
Kavanaugh, et al, 2006¹⁰	Stratified randomization with algorithm	^*	Computer-generated	^*	Administered by blinded investigators	^*	Patients unaware of whether they received drug or PBO	^*	No. patients for productivity assessment not provided	^**	None identified	^*	None identified	^*
Kavanaugh, et al, 2009¹¹	Centralized interactive voice-Web response system	^*	Interactive voice response system	^*	PBO and drug not distinguished	^*	Assessed by independent assessors with no record access	^*	No. employed participants not provided	^**	None identified	^*	None identified	^*
Kavanaugh, et al, 2012¹²	Centralized interactive voice-Web response system	^*	Interactive voice response system	^*	Participant and physicians blinded to intervention and dosage	^*	Not described	^**	No. employed participants not provided	^**	None identified	^*	None identified	^*
Kavanaugh, et al, 2015¹³	Stratified randomization with interactive voice response system	^*	Interactive voice response system	^*	Dose-blinded participants and personnel with blinded prefilled syringes	^*	Not described	^**	Biologic-naive not separated from biologic-experienced	^**	None identified	^*	None identified	^*
Zhang, et al, 2014¹⁴	Not described	^**	Not described	^**	Not described	^**	Blinded investigators	^*	No. employed participants not provided	^**	None identified	^**	None identified	^*

Table 3.

Self-reported work productivity, absenteeism, and presenteeism.

Study, Yr	Treatment	Tool Used to Measure Work Productivity	Range^*	Measurement of Self-reported Work Productivity	Change in Self-reported Work Productivity	Measure of Variability for Self-reported Work Productivity	Absenteeism^◊	Presenteeism^§
Kavanaugh, et al, 2006¹⁰	PBO	VAS	(0–10)	Median VAS score change from baseline	−0.3	IQR (−1.5, 1.5)	0	NR
Kavanaugh, et al, 2006¹⁰	IFX, 5 mg/kg				−2.6^**	IQR (− 0.5, −5)	−9.3	NR
Kavanaugh, et al, 2009¹¹	PBO	VAS	(0–10)	Mean VAS score change from baseline	−0.08	SD (2.6)	0.4	NR
	GOL, 50 mg				−1.9^**	SD (2.7)	1.6	NR
	GOL, 100 mg				−2.6^**	SD (3)	2.3	NR
Kavanaugh, et al, 2012¹²	PBO	VAS	(0–10)	Mean VAS score change from baseline	−0.78	NR	NR	NR
	UST, 45 mg				−1.82^**	NR	NR	NR
	UST, 90 mg				−2.64^**	NR	NR	NR
Kavanaugh, et al, 2015¹³	PBO	WPS	(0–10)	Mean WPS score change from baseline	−1	NR	−1	−0.3
	CZP, 200 mg				−2.7^NR	NR	−1.8^NR	−3.9^**
	CZP, 400 mg				−1.9 ^NR	NR	−1	−3^**
Zhang, et al, 2014¹⁴	PBO	WLQ	(0–10) ^{^Ŧ}	Median % improvement of productivity loss	0.37	NR	NR	NR
	APR, 20 mg				−1.89^NR	NR	NR	NR
	APR, 30 mg				−2.47 ^NR	NR	NR	NR

↵* Lower VAS, WPS, and WLQ scores represent greater work productivity.
↵** Statistically significant difference compared to PBO at a 0.05 level.
↵◊ Days missed from work per month.
↵§ Days with reduced productivity per month.
↵Ŧ Scores were transformed from a 0–100 scale. PBO: placebo; IFX: infliximab; GOL: golimumab; UST: ustekinumab; CZP: certolizumab pegol; APR: apremilast; VAS: visual analog scale; WPS: Work Productivity Survey; WLQ: Work Limitations Questionnaire; IQR: interquartile range;
↵NR: statistical significance level not reported; NR: not reported.