Ab0736 gender Influence on Treatment Effectiveness in Psoriatic Arthritis

Abstract

BackgroundGender has been lately suggested as influential in the response to treatment with biological drugs in spondyloarthritis, such as psoriatic arthritis (PsA). However, data about the association between gender and treatment response in axial PsA (axPsA) or peripheral PsA (pPsA) are scarce.ObjectivesTo analyze the association between gender and clinical response to biological therapy in patients with axPsA and pPsA.MethodsAn observational cohort study was conducted, prospectively collecting data from 108 patients treated with biological therapy (93% TNFi and 7% IL-17i) from 2002-2018. Patients were divided into two groups according to their clinical predominant manifestation: axPsA or pPsA. Disease activity indexes (ASDAS and BASDAI for axPsA and DAPSA and DAS28 for PsA) were collected before starting drug and 6 months later (baseline and 6m visit, respectively). Low disease activity (LDA) was defined as aSDAS <2.1 or BASDAI <4 (axPsA) and DAPSA ≤14 or DAS28 ≤ 3.2 (pPsA). Clinical improvement was defined as an improvement ≥ 1.1 points in aSDAS (dASDAS) or 50% in BASDAI (BASDAI50) for axPsA, and an improvement of 50% in DAPSA (DAPSA50) or dDAS28 ≥ 1.2. First, the frequency of male- and female-patients achieving LDA and clinical improvement at 6m were compared using Fisher test, separately for axPsA and pPsA. Second, the association between gender and each of the clinical outcomes was analyzed using logistic regression models adjusted for confounders (age, disease duration, previous biologics, smoking habit, body mass index (BMI), baseline DMARDs and baseline disease activity (ASDAS or BASDAI for axPsA and DAPSA or DAS28 for pPsA).ResultsOut of 108 included patients, 55 (51%) had predominant axPsA and 54 (49%) pPsA. In the group of axPsA, 35 (64%) were males, 33 (60%) were non-smokers, 33 (60%) had a BMI ≥25, with mean (SD) baseline disease activity of aSDAS: 3.3 (1.0) and BASDAI: 5.4 (2.0). The frequency of patients achieving clinical response was higher in males than females (LDA: 74% vs 37%; p=0.02, respectively) (Table 1). After adjusting for confounders, male gender was significantly associated with higher probability of achieving LDA (ASDAS OR=4.4; p=0.03 and BASDAI OR=6.0; p=0.01), and clinical improvement (dASDAS: OR=4.8; p=0.04 and BASDAI50: OR=5.19; p=0.03). In the group of pPsA, 20 (37%) were males, 37 (68%) were non-smokers, 34 (63%) had a BMI ≥25, with mean (SD) baseline disease activity indexes of DAPSA: 26 (14.9) and DAS 28: 4.8 (1.2). The frequency of patients achieving LDA was higher in males than females (74% vs 39%; p=0.02, respectively). After adjusting for cofounders, male gender was independently associated with higher probability of achieving LDA by DAPSA (OR=4.0; p=0.03) and DAS28 (OR= 2.1; p=0.3). Finally, an association between male gender and clinical improvement was also observed but this was statistically significant only when using dDAS28 as the outcome: OR=2.9; p=0.1 for DAPSA50 and OR=5.8; p=0.02 dDAS28.ConclusionMale gender is associated with a higher rate of response to biolog...

Sex-Specific Differences in Patients With Psoriatic Arthritis: A Systematic Review

“…Of the included studies, 11 were prospective cohort or observational studies, [13][14][15][16][17][18][19][20][21][22][23] including 1 post hoc analysis of a prospective observational study. 15 In total, 5 included studies were retrospective observational studies, [24][25][26][27][28] and 9 were cross-sectional studies.…”

“…[29][30][31][32][33][34][35][36][37] Only 1 study was reported as a qualitative research study 38 and, finally, 1 study was reported as a population-based cohort study. 39 Population size varied greatly across the included studies, from 108 patients 14 to 8677 patients 25 (Supplementary Table S7, available with the online version of this article). Quality assessment.…”

“…In 6 studies, patients initiated a biologic disease-modifying antirheumatic drug (bDMARD) as part of their inclusion. 13,14,17,18,22,23 In total, 7 further studies reported current or prior bDMARD exposure, by sex. One study reported significantly greater current or prior bDMARD exposure in women, 29 and 1 study reported significantly greater current bDMARD exposure in men, but no significant difference for overall exposure.…”

Responses to Ixekizumab in Male and Female Patients with Psoriatic Arthritis: Results from Two Randomized, Phase 3 Clinical Trials

“…A real-world analysis of patients with PsA using data from the Corrona registry showed patients who discontinued a new TNFi treatment by the first follow-up visit were more likely to be women with higher disease activity and worse PROs than patients who continued with the defined index treatment; however, the difference between men and women was only significant among TNFi-experienced patients [ 25 ]. In a prospective observational study of 108 patients treated with biological therapy (93% TNFi and 7% IL-17i), male sex was associated with a higher rate of response to biological treatment in both axial PsA and peripheral PsA; however; in a real-world setting, secukinumab improved disease activity and depressed mood in both men and women with PsA, although women demonstrated an overall higher disease burden [ 26 , 27 ].…”