OBJECTIVES: To quantify work productivity among patients with axial spondyloarthritis (axSpA) treated with biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs).

METHODS: A systematic literature review (SLR) was conducted according to PRISMA guidelines. MEDLINE, Embase, EconLit, Cochrane, and relevant conference proceedings were searched for randomized and non-randomized studies with a b/tsDMARD in axSpA reporting on health-related quality of life and productivity outcomes. Studies published between 2010 and October 21, 2021 that included results from any version of the Work Productivity and Activity Impairment (WPAI) questionnaire were analyzed. These scores represent the percentage of time that individuals were unproductive due to absenteeism, presenteeism, overall work impairment, and impairment during daily activities due to axSpA. A random-effects meta-analysis was performed for each WPAI domain (absenteeism, presenteeism, work impairment, and activity impairment) using mean change in WPAI score from baseline. Outcomes reported between 12 and 16 weeks were pooled.

RESULTS: A total of 5580 records were identified and 412 were selected for full-text review. Among 180 included records representing 62 unique studies, 19 reported WPAI outcomes. The majority of analyzed studies were randomized trials (n=11), followed by prospective observational studies (n=7), and one single-arm trial. Seventeen studies evaluated patients with ankylosing spondylitis (AS) and four studies evaluated those with non-radiographic axSpA. The proportion of patients employed varied widely (33%–100%). In all studies, presenteeism was a greater contributor to overall work impairment than absenteeism. Among patients taking b/tsDMARDs and placebo, mean change in WPAI score from baseline at 12–16 weeks was –5.7 vs –0.5 for absenteeism, –20.6 vs –11.2 for presenteeism, –20.8 vs –11.1 for work impairment, and –21.2 vs –11 for activity impairment.

CONCLUSIONS: In axSpA, presenteeism is the predominant contributor to work impairment. Treatment with b/tsDMARDs is associated with improvements in productivity across all WPAI domains at 12–16 weeks.