TNFi More Effective in Men vs Women With Psoriatic Arthritis

man being checked for hand RA
man being checked for hand RA
Male gender was associated with better biologic treatment effectiveness in psoriatic arthritis.

In patients with psoriatic arthritis (PsA) who initiated tumor necrosis factor (TNF) inhibitor therapy, male gender was associated with better treatment effectiveness, independent of known risk factors and baseline imbalances, according to the results of an observational nationwide cohort study published in Rheumatology.

The researchers sought to explore gender differences in disease manifestations, patient-reported outcomes, treatment effectiveness, and comorbidities in patients with PsA who received treatment with their first TNF inhibitor. The DANBIO register provided prospectively obtained data on patients with PsA who initiated their first TNF inhibitor therapy between 2000 and 2015. The Danish Health Care Register provided data on patient comorbidities. Response to treatment was evaluated according to European League Against Rheumatism (EULAR) and American College of Rheumatology criteria at 3 and 6 months.

A total of 1750 patients with PsA, including 935 women, were included in the analysis. At baseline, women were significantly older than the men (49 years vs 47 years, respectively). Moreover, women smoked significantly more often than the men (32% vs 26%, respectively), had significantly worse patient-reported scores than the men (global score, 71 mm vs 65 mm, respectively), and had significantly higher rates of hospital-diagnosed depression or anxiety (7% vs 4%, respectively) and chronic obstructive pulmonary disease (7% vs 3%, respectively; P <.01 for all parameters).

Median TNF inhibitor persistence was 3.8 years (95% CI, 3.0-5.7) in men compared with 1.4 years (95% CI, 1.1-1.8) in women (P <.001). Moreover, men exhibited significantly higher odds of attaining a response after 3 and 6 months (adjusted odds ratio, 3.2; 95% CI, 1.6-6.1) for good to moderate response according to EULAR criteria vs women at 6 months.

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The investigators concluded that male gender was strongly linked to greater TNF inhibitor treatment efficacy. Adjustment for such baseline risk factors as disease activity, comorbidities, lifestyle factors, and patient-reported outcomes did not affect this relationship, which suggests a possible role of biologic factors.

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Højgaard P, Ballegaard C, Cordtz R, et al. Gender differences in biologic treatment outcomes-a study of 1750 patients with psoriatic arthritis using Danish Health Care Registers [published online June 9, 2018].  Rheumatology (Oxford). doi:10.1093/rheumatology/key140