1. SICK LEAVE AND DISABILITY PENSION BEFORE AND AFTER INITIATION OF ANTIRHEUMATIC THERAPIES IN CLINICAL PRACTICE Neovius M, Simard JF, Klareskog L & Askling J for the ARTIS Study Group Ann Rheum Dis 2011;70(8):1407-14. PMID: 21518724

2. Background Antirheumatic treatment Anti-TNF drugs constituted 5% of the total national drug expenditure in Sweden in 2009 (excl OTC-drugs) Work force participation Productivity losses in the RA population are large Effects on productivity hold potential for offsetting some of the treatment cost

4. Background Neovius M, Simard JF, Askling J. How large are the productivity losses in contemporary patients with RA, and how soon in relation to diagnosis do they develop? Ann Rheum Dis 2011;70(6):1010-15.

5. Objective To assess annual days on sick leave & disability pension before & after antirheumatic treatment initiation in a nationwide RA cohort

6. Methods Patients – 19-60y old patients with RA initiating treatment in 1999-2007 – Identified in the Swedish Rheumatology Quality Register (SRQ), including the Swedish Biologics Register ARTIS Treatment cohorts – Mono-DMARD(n=2,796) – Combo-DMARD(n=973) – Biologics(n=4,787) Outcome – Annual net days on sick leave & disability pension (max 365 days) – From the Swedish Social Insurance Agency (1995 to 2010)

7. Prevalence of RA by Age and Sex (Jan 1, 2008; n=58 102) Neovius, Simard & Askling for the ARTIS Study Group Ann Rheum Dis. 2011 45% <65y

8. Results 1.By Month 2.By Year 3.By Calendar Period

13. 2 BY YEAR Sick leave vs disability pension Mean days by therapy Median days & distribution of days by therapy 2

17. 2 Neovius M, Simard JF, Klareskog L & Askling J for the ARTIS Study Group, Ann Rheum Dis. 2011

18. 3 BY CALENDAR PERIOD

20. Conclusion History of increasing productivity losses The patient group selected for therapy was characterized by a history of rapid increases in annual sick leave & disability pension days Breakpoint but no reversal Treatment was associated with a breakpoint in this pattern, but days off work remained far from the level observed before RA-diagnosis A large unmet need remains Intervention appears to be needed earlier in the disease process

21. Related Articles from SRQ/ARTIS Askling J, Fored CM, Geborek P, Jacobsson LT, van Vollenhoven R, Feltelius N, Lindblad S, Klareskog L Swedish registers to examine drug safety and clinical issues in RA Ann Rheum Dis 2006;65(6):707-12. Neovius M, Simard JF, Askling J for the ARTIS Study Group How large are the productivity losses in contemporary patients with RA, and how soon in relation to diagnosis do they develop? Ann Rheum Dis 2011;70(6):1010-15. Simard JF, Arkema EV, Sundstrom A, Geborek P, Saxne T, Baecklund E, Coster L, Dackhammar C, Jacobsson L, Feltelius N, Lindblad S, Rantapaa-Dahlqvist S, Klareskog L, van Vollenhoven RF, Neovius M, Askling J Ten years with biologics: to whom do data on effectiveness and safety apply? Rheumatology (Oxford) 2011;50(1):204-13. Neovius M, Simard JF, Askling J for the ARTIS Study Group Nationwide prevalence of rheumatoid arthritis and penetration of disease-modifying drugs in Sweden Ann Rheum Dis 2011;70(4):624-29. Neovius M, Simard J, Sundstrom A, Jacobsson L, Geborek P, Saxne T, Feltelius N, Klareskog L, Askling J. Generalisability of clinical registers used for drug safety and comparative effectiveness research: coverage of the Swedish Biologics Register. Ann Rheum Dis 2011;70(3):516-19.