Issue: July 2024
Fact checked byShenaz Bagha

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May 22, 2024
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TNF inhibitor efficacy in axial spondyloarthritis varies greatly by sex via BASDAI score

Issue: July 2024
Fact checked byShenaz Bagha
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Key takeaways:

  • TNF inhibitor efficacy according to BASDAI score varies significantly between men and women with axial SpA.
  • Sex differences between scores could impact judgment of treatment response in practice.

The effectiveness of TNF inhibitors for axial spondyloarthritis varies significantly between men and women based on BASDAI score, but not ASDAS, according to data published in Arthritis Research & Therapy.

After 1 year of treatment, men were more likely to demonstrate effective response according to the Bath Ankylosing Spondylitis Disease Activity Score (BASDAI), while there was no significant difference in response between men and women under the Ankylosing Spondylitis Disease Activity Score (ASDAS).

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The effectiveness of TNF inhibitors for axial SpA can vary significantly between men and women depending on which disease activity measure is used. Image: Adobe Stock

“Different disease characteristics of [axial SpA] between sexes have been recognized,” Seulkee Lee, MD, PhD, of the Sungkyunkwan University School of Medicine, in Seoul, South Korea, and colleagues wrote. “Various recommendations suggest utilizing disease activity scores, such as the BASDAI or ASDAS, as criteria for [TNF inhibitor] initiation and assessment of treatment efficacy. Despite the differences in reporting of disease activity scores between sexes, the criteria for both males and females remained the same, which could potentially impact the assessment of medication efficacy.”

To examine possible sex differences in disease activity scores — and their potential impacts on whether treatment is deemed effective — Lee and colleagues analyzed data from the prospective, nationwide Korean College of Rheumatology Biologics and Targeted Therapy Registry. The team examined 1,753 adult patients with axial SpA (mean age, 39.69 years; 76.6% male) who started TNF inhibitors at baseline between December 2012 and August 2021, and had at least 1 year of follow-up. Their analysis compared baseline disease activity scores according to BASDAI and ASDAS with scores assessed at 1 year.

“Historically, the BASDAI has been widely used as a clinical measure for assessing disease activity in [axial SpA],” Lee and colleagues wrote. “However, it is a fully patient-oriented metric that is not specific to the inflammatory response, does not reflect the importance of each variable, and does not account for redundancies between variables. The ASDAS was developed more recently than the BASDAI. The ASDAS is expected to be more objective than the BASDAI because it includes inflammatory markers.”

Treatment efficacy under BASDAI was defined as a score reduction of 50% or more, or a reduction of two or more. Meanwhile, ASDAS efficacy was defined as a score reduction of 1.1 or more. Between-sex comparisons were conducted using multivariate linear regression, with positive beta coefficients indicating that men saw greater change in the disease activity measure.

According to the researchers, the analysis demonstrated that BASDAI and PGA changes were independently associated with sex (BASDAI beta coefficient = 0.343; PGA beta coefficient = 0.491), while ASDAS had no significant association with sex (beta coefficient = 0.079). At 1 year, BASDAI was more likely to meet efficacy criteria in men (OR = 1.7; 95% CI, 1.2-2.406), while there was no significant difference for ASDAS (OR = 0.993; 95% CI, 0.678-1.455).

“This study shows that there were differences in changes in disease activity measured by BASDAI and ASDAS between sexes in real-world settings and that these differences may lead to different judgments of treatment response between sexes in practice,” Lee and colleagues wrote. “Disease activity changes before and after [TNF inhibitor] use were significantly different between male and female patients, as measured by the BASDAI, but not by the ASDAS.”