Although men with rheumatoid arthritis (RA) are often prescribed different initial treatments compared with women with RA, there are no differences in response to treatment between the sexes, according to results published in The Journal of Rheumatology.

The study included participants with RA starting different antirheumatic treatments from the international, observational METEOR register (n=5535). The researchers compared response to treatment using visits from the start of the first disease-modifying antirheumatic drug (DMARD) therapy until the first DMARD switch or until the end of follow-up. The researchers calculated the effect of sex on time to switch from first to second treatment and whether men and women responded differently to treatments.

Women with RA (n=4393) were more likely to start treatment with hydroxychloroquine as monotherapy or in combination with methotrexate or a glucocorticoid. Men with RA (n=1142), on the other hand, were more likely to start treatment with methotrexate or sulfasalazine.

The time to a DMARD switch was shorter for women with RA (median, 175 days; n=2756) compared with men (median, 200 days; n=647).

Differences in improvement in Disease Activity Score (DAS) over time was negligible between men (β= –0.69; 95% CI, –0.75 to –0.62 per year) and women (β= –0.58; 95% CI, –0.62 to –0.55 per year).

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After performing subanalyses for each DMARD group, the researchers found that the conventional synthetic DMARD combination therapy resulted in a slightly greater decrease in DAS over time for men with RA (β= –0.89; 95% CI, –1.07 to –0.71) compared with women (β= –0.59; 95% CI, –0.67 to –0.51); however, these differences were clinically insignificant.

“This indeed suggests a slightly less aggressive approach in women compared to men: [hydroxychloroquine] monotherapy reportedly has only a small effect in reducing the swollen joint count, and its effects on delaying joint damage are smaller compared to [sulfasalazine],” the researchers wrote.

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Reference

Bergstra SA, Allaart CF, Ramiro S. Sex-associated treatment differences and their outcomes in rheumatoid arthritis: results from the METEOR register [published online June 15, 2018]. J Rheumatol. doi:10.3899/jrheum.171176