Using biologics to help workers with inflammatory conditions

Inflammatory conditions have the power to severely affect employees’ productivity and general quality of life.

But new biologic treatments are raising the success rates for sufferers, according to Aaron Sihota, primary care pharmacist and clinical instructor at the University of British Columbia’s faculty of pharmaceutical sciences, at Benefits Canada’s 2019 Vancouver Benefits Summit at the Fairmont Waterfront Hotel on May 24.

“Why do we care about inflammatory conditions in the workplace? Often these conditions impact young lives,” he said. “They start in the third or fourth decade of life and it’s counterintuitive. . . . You might think of it as a disease of old age but they’re not.”

Read: Psoriasis – A look below the surface

One condition causing major problems is psoriasis, said Sihota. “When you look at the impact on work productivity, [it’s] 2.2 hours of missed work just because of the psoriasis. And we’re talking about more mild psoriasis — 16 per cent work impairment — so their ability to actually function day to day in a productive manner; [and] $749 million in lost wages just because of a skin condition. Often we don’t think about skin conditions as chronic . . . but psoriasis is a chronic disease.”

At the outset, psoriasis is traditionally treated by oral medications, since these have a reasonable amount of efficacy given their cost-effectiveness, he said. While not all patients need to progress to a biologic, depending on the severity of their condition, he noted certain new treatments are able to accelerate improvements in symptoms, as well as the number of patients experiencing these improvements.

One newly approved biologic molecule has boosted most patients to 90 per cent improvement from the baseline in a year’s time, said Sihota. “So if your body is full of lesions and psoriatic plaques, when you look at a 90 per cent improvement from baseline, 80 per cent of patients by week 52 demonstrate that level of efficacy. In the past, the benchmark used to be 75 per cent, so maybe seven or eight years ago, 75 per cent improvement from baseline was considered to be awesome. We’re now moving into an era where we’re looking at 100 per cent skin lesion clearance.”

Read: Using biologics in atopic dermatitis therapy

Total clearance can mean so much to patients because psoriasis symptoms harm more than just the skin, he said. “People don’t really realize this. Let’s say there’s a patient: they’re being treated by a rheumatologist [and] they’re looking specifically at the skin or the joints,” said Sihota. “No one is really taking care of the surrounding, what’s going on beneath the skin. And often patients do suffer from metabolic syndrome. They’re at a higher risk of developing psoriatic arthritis . . . , which also involves joint manifestation, so inflammation of the joints, finger or feet.”

There’s also an increased risk of cardiovascular disease, as well as depression and anxiety stemming from the outward expression of the disease’s impact on the patient’s ability to engage socially. As well, psoriasis sufferers are more likely to experience effects on the bowels. And psoriatic arthritis, which can often develop as a result of arthritis, is especially problematic for employees, said Sihota. Things most people take for granted, such as buttoning up a shirt, using a steering wheel or even a keyboard, are extremely difficult and painful for those with this disease.

Read: Is nudging biologic patients towards biosimilars a good choice?

“We often treat these guys with disease modifying anti-rheumatic agents, again similar to what we are treating psoriasis initially with. Those orals, they’re cost effective, they have some decent demonstrated efficacy. And if, over time, we find these medications aren’t working, we’ll look at other options — biologics.”

It’s very easy for a person with psoriatic arthritis not to be able to come into work because of the pain or fatigue, he added.

“We want to avoid those downstream effects as well as those costs. It’s so important. I think the other key thing is, we don’t realize when someone leaves the workforce like that, it’s very difficult and costly to hire someone, onboard someone and retrain them. There are costs associated with that and we don’t think about that.”

Read more stories from the 2019 Vancouver Benefits Summit