Female patients with psoriatic arthritis less likely to achieve therapy goals on bDMARDs
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Female patients with psoriatic arthritis who receive biologic disease-modifying antirheumatic drugs are more likely to have more severe disease and less likely to reach low or minimal disease activity vs. male patients, according to data.
“Epidemiological evidence suggests that the prevalence of psoriatic arthritis (PsA) is similar across genders, but gender-related differences have not been thoroughly explored in PsA,” Arno W. R. Van Kuijk, MD, PhD, of the Amsterdam Rheumatology and Immunology Center, in the Netherlands, and colleagues wrote in Rheumatology. “A number of studies have analyzed various aspects of the disease, from baseline characteristics and disease perception to treatment response (mostly to tumor necrosis factor inhibitors [TNFi]) and patient outcomes, in men and women separately.”
To investigate whether male and female sex among patients with PsA are associated with different reactions to biologic DMARDs, Kuijk and colleagues conducted a new analysis of the PsABio study. According to the researchers, PsABio is a prospective, real-world, observational cohort study investigating ustekinumab (Stelara, Janssen) or a TNF inhibitor as a first, second or third-line therapy in PsA. For this analysis, the researchers compared male and female patient outcomes regarding disease activity, patient-reported outcomes and treatment persistence.
Patient data were compared at 6 and 12 months. Outcomes of interest included the clinical disease activity index for PsA (cDAPSA), the Health Assessment Questionnaire-Disability Index (HAQ-DI) and the total Psoriatic Arthritis Impact of Disease-12 score (PsAID-12).
The analysis included 512 female patients and 417 male patients. Prior to starting biologic DMARDs, the average score for the cDAPSA was 32.3 (95% CI, 30.3-34.2) in female patients and 26.8 (95% CI, 24.8-28.9) for male patients. Meanwhile, the average baseline score for female patients on the HAQ-DI was 1.3 (95% CI, 1.2-1.4), compared with 0.93 (95% CI, 0.86-0.99) for male patients. In addition, female patients demonstrated a higher average total PsAID-12 score, at 6 (95% CI, 5.8-6.2) vs. 5.1 (95% CI, 4.9-5.3) for male patients.
Overall, female patients experienced smaller improvements than their male counterparts, according to the researchers. At 12 months, 57.8% of 303 female patients, compared with 80.3% of 264 male patients, achieved cDAPSA low disease activity, while 33.7% of 285 female patients, vs. 55.5% of 247 male patients, achieved minimal disease activity.
In addition, HAQ-DI scores were 0.85 (95% CI, 0.77-0.92) for female patients compared with 0.5 (95% CI, 0.43-0.56) for male patients, while PsAID-12 scores 3.5 (95% CI, 3.3-3.8) vs. 2.4 (95% CI, 2.2-2.6), respectively.
Treatment persistence was also lower among female patients, compared with male patients (P=<.001). The most common reason for ceasing treatment, across sexes and biologic DMARDs, was lack of effectiveness.
“These real-world data from PsABio on gender differences suggest that, at the start of biologic treatment, females have a worse clinical picture of PsA than males,” Van Kuijk and colleagues wrote. “Although treatment improvements were seen in both genders, a lower percentage of women reached a favorable disease state of low or minimal disease activity at 1 year, and more women stopped/switched biologic due to both lower effectiveness of the treatment and [adverse events].”
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