Female patients with RA receiving exogenous sex hormones more likely to achieve remission
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Female patients with rheumatoid arthritis are more likely to achieve remission when treated with exogenous sex hormones, particularly those who are perimenopausal and early postmenopausal, according to data published in Rheumatology.
The researchers additionally concluded that perimenopausal women were less likely to achieve RA remission, compared with premenopausal RA patients.
“Although, the cause of these sex-based differences is unknown, they indicate a potential impact of sex-related factors, such as reproductive status and sex hormones, on rheumatoid arthritis treatment outcome,” Dala N. Daraghmeh, PharmD, of the University of South Australia, in Adelaide, told Healio.
To investigate whether factors influencing female sex hormones — such as reproductive status and exogenous sex hormone use — are associated with the efficacy of disease-modifying antirheumatic drugs in patients with RA, Daraghmeh and colleagues studied data from five phase 3 randomized controlled trials. In every included study, patients with moderate-to-severe active RA received either conventional synthetic DMARDs or tocilizumab (Actemra, Genentech).
Four studies included patients who demonstrated a less-than-optimal response to DMARDs. One trial included patients who were naïve to DMARDs and methotrexate. Background use of systemic corticosteroids and NSAIDs were allowed for use by patients in all trials, the authors wrote.
The authors constructed four baseline status groups, including premenopausal, which included premenopausal women aged 45 years and younger; perimenopausal, which included premenopausal women aged 45 years and older; early post-menopausal, which featured post-menopausal women aged 45 and younger; and post-menopausal, made up of post-menopausal women aged 45 years or older.
Demographic, clinical and disease characteristics were available for baseline evaluations. Disease activity measures, including the simplified disease activity index, clinical disease activity index and the DAS28 with erythrocyte sedimentation rate (DAS28-ESR), were evaluated at baseline and throughout the trials. The primary outcome measure was the time to the first RA remission activity based on SDAI. Secondary outcomes were the time to remission according to the other measures listed. The primary remission predictors were the reproductive status of the patients and their use of exogenous sex hormone at baseline.
The analysis included a total of 4,474 patients. Of those, 2,817 were post-menopausal, 202 were early post-menopausal, 1,021 were premenopausal and 414 were perimenopausal. Additionally, 221, 13, 255 and 47 of those patients were receiving exogenous sex hormones, respectively. In a pooled analysis, patients with a perimenopausal status demonstrated a reduced chance of reaching remission compared with patients who were premenopausal (adjusted HR = 0.78; 95% CI, 0.61-0.99). Patients receiving hormones had “significantly” higher rates of remission (aHR = 1.2; 95% CI, 1.01-1.43).
“Perimenopausal and early post-menopausal patients who were taking exogenous sex hormone therapies had an improved remission likelihood compared to counterparts who were not taking exogenous sex hormones,” Daraghmeh said. “This study adds to the collective evidence on the relationship between sex-related factors and the efficacy of DMARDs and informs therapeutic strategies for female patients with rheumatoid arthritis.”
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