P269 Real-world impact of biological therapies on work impairment and quality of life in Inflammatory Bowel Disease patients.
Thomas, P.(1);Den Broeder, N.(2);West, R.(3);Russel, M.(4);Jansen, J.(5);Römkens, T.(6);Hoentjen, F.(2);
(1)Radboudumc, Gastroenterology, Nijmegen, The Netherlands;(2)Radboudumc, Gastroenterology and Hepatology, Nijmegen, The Netherlands;(3)Franciscus Gasthuis & Vlietland, Gastroenterology and Hepatology, Rotterdam, The Netherlands;(4)Medisch Spectrum Twente, Gastroenterology and Hepatology, Enschede, The Netherlands;(5)Onze Lieve Vrouwe Gasthuis, Gastroenterology and Hepatology, Amsterdam, The Netherlands;(6)Jeroen Bosch Ziekenhuis, Gastroenterology and Hepatology, 's-Hertogenbosch, The Netherlands
Background
Randomised controlled trials have reported improvement of work productivity and activity impairment (WPAI) as well as quality of life in biological-treated inflammatory bowel disease (IBD) patients. However, data beyond clinical trials are limited.
Methods
This multicentre prospective cohort study evaluated the effect of initiating biological or small molecule therapy on work impairment in IBD patients. Subjects completed the WPAI questionnaire and Short IBD questionnaire (SIBDQ) at biological therapy initiation and at week 26. Clinical disease activity was assessed using the Harvey Bradshaw Index and Simple Clinical Colitis Activity Index. Biochemical disease activity was assessed using C-reactive protein and faecal calprotectin. Data are presented as mean ± standard deviation.
Results
In total, 156 IBD patients were included for analysis (median age 40 years, 55% male, 55% Crohn’s disease). Of these patients, 28% started infliximab, 33% adalimumab, 19% vedolizumab, 18% ustekinumab, 1% tofacitinib and 1% golimumab. Concomitant medication use at baseline included 28% prednisone, 12% budesonide, 34% mesalamine, and 46% immunomodulator. At baseline, 58% had clinical disease activity and 58% had biochemical disease activity. In our cohort, 111 (71%) were employed and 17 (11%) patients reported partial or full occupational disability. The mean total work impairment at baseline was 52% ± 36%. During follow-up, 7 patients lost their job and 8 patients started employment. For the entire cohort, improvements in all WPAI domains were observed: mean 11%-points decrease in missed working hours, 4%-points decrease in impairment while working, 15%-points decrease in total work impairment and 15%-points decrease in total activity impairment. Parallel improvements were seen in SIBDQ scores (mean improvement 7.6 ± 11.3). At week 26, 66 (42%) patients achieved the minimal clinical important difference in total work impairment (improvement ≥7%-points). Patients with clinical disease activity at baseline and clinical response to the biological (n=32) showed a larger improvement in total work impairment compared with other subjects (n=86) (mean difference 29%-points versus 10%-points; p=0.036 (T-test)). Similarly, these patients showed greater improvement in SIBDQ scores compared to other subjects (mean 13.8 versus 5.4, respectively; p<0.001 (T-test)).
Conclusion
IBD patients experienced substantial work impairment prior to initiating biological treatment. Improved work impairment scores were seen after initiation of biological therapy and patients with clinical response showed even greater improvements. These results underline the importance of IBD disease control to improve work productivity and participation.