The effect of guselkumab treatment on work productivity and daily activity in patients with PsA

Introduction

Psoriatic arthritis (PsA) can affect the quality of life of patients by impacting their daily lives and ability to work. Here, we discuss results from the phase III DISCOVER-2 trial that assessed the daily activity and work productivity of biologic naïve patients with PsA who were treated with guselkumab for one year, with an additional year of post-hoc analysis.¹

Guselkumab is an inhibitor of the p19 subunit of interleukin-23. The study design can be seen in our previous article which presented health-related quality of life outcomes (EQ-5D-5L and EQ-VAS) from the DISCOVER-2 trial. Patients included in DISCOVER-2 received either guselkumab every 4 or 8 weeks or placebo (from Week 24, patients receiving placebo could crossover to receive guselkumab every 4 weeks).¹

Baseline work productivity and daily activity¹

A total of 738 patients reported daily activity at baseline, with 475 patients employed at baseline and therefore able to report work productivity scores. The majority of patients were white (≥97% across groups), with an average PsA disease duration of 5–6 years. Patients had active disease, with an average of 12–13 swollen joints, 20–22 tender joints, and mean Psoriasis Area and Severity Index (PASI) score of 9.3–10.8. Patients had a mean 36-Item Short Form Health Survey (SF-36) Physical Component Score (PCS) of 32.4–33.3, with an average SF-36 PCS score of 50 reported for the U.S. population as a whole. The work productivity and daily non-work activity at baseline is presented in Figure 1.

Figure 1. Work productivity and daily activity at baseline* 

PsA, psoriatic arthritis.
*Adapted from Curtis.¹

Work impairment due to PsA can be spilt into absenteeism and presenteeism (Figure 2). Approximately 10% work impairment was missed work due to PsA, which equates to an average of 2 missed days of work per month, whereas 46.9–49.3% of work impairment was due to presenteeism.

Figure 2. Work missed due to PsA* 

PsA, psoriatic arthritis.
*Adapted from Curtis.¹

Impact of guselkumab on work productivity and daily activity¹

Improvements were seen in both the work productivity and daily activity of patients treated with guselkumab through to Week 100. The proportion of patients achieving a minimally important difference in daily non-work activity and work productivity is shown in Figure 3.

Figure 3. Proportion of patients achieving MID in A daily activity and B work productivity* 

MID, minimally important difference.
*Adapted from Curtis.¹

†MID defined as ≥20% improvement among patients with ≥20% impairment at baseline.

‡MID defined as ≥15% improvement among patients with ≥15% work productivity.

Among patients who were employed at baseline, ≥84% remained in employment through to Week 100 regardless of guselkumab dosing regimen. In patients who were not employed at baseline, 20.0–25.3% were employed at Week 100.

Conclusion

This study showed the impact PsA can have on daily life for patients. At baseline, ~50% of patients reported impairments in their daily activity or work productivity due to their PsA; however, both guselkumab dosing regimens allowed the majority patients to achieve minimally important differences in both daily activity and work productivity by Week 100. However, Curtis acknowledged that this cost saving is likely to vary largely when professions and salaries are taken into account. Nevertheless, treatment with guselkumab was shown to improve daily activity and work productivity compared with placebo which may enable more people to gain employment. Gaining and maintaining employment may improve quality of life for these patients, allowing them to live life less affected by psoriatic disease.