Gender Affects Treatment Response in Axial Spondyloarthritis

TOPLINE:

Male patients with axial spondyloarthritis who received advanced therapies showed higher response rates than female patients, with similar differences observed across different medication classes.

METHODOLOGY:

• Researchers conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate sex-related differences in efficacy outcomes among patients with axial spondyloarthritis who received advanced therapies (biologics or targeted synthetic disease-modifying antirheumatic drugs).
• Of the 79 RCTs (23,748 participants) included, 75 RCTs reported sex distribution, showing an overall male/female ratio of approximately 2:1 (3src.3% female patients).
• Only a few trials reported data by sex, with nine trials (11.4%) reporting baseline characteristics, 22 trials (28%) reporting efficacy endpoints, and nine trials (11.4%) reporting safety endpoints.
• They extracted data on the proportion of patients achieving three efficacy endpoints by sex: Assessment of Spondyloarthritis International Society (ASAS) 2src/4src response criteria, Bath Ankylosing Spondyloarthritis Disease Activity Index (BASDAI) 5src response, and Axial Spondyloarthritis Disease Activity Score–low disease activity or inactive disease (ASDAS-LDA/ID).

TAKEAWAY:

• Female patients were significantly older and reported higher pain scores at baseline than male patients, who had higher C-reactive protein levels and lower BASDAI scores.
• Male patients were more likely than female patients to achieve an ASAS4src response across all advanced therapies (odds ratio [OR], 1.88; 95% CI, 1.44-2.46) and for both interleukin 17A (IL-17A) and tumor necrosis factor (TNF) inhibitors.
• Similarly, male patients had a higher likelihood of achieving an ASAS2src response across all therapies (OR, 1.79; 95% CI, 1.19-2.69) than female patients, particularly with TNF inhibitors (OR, 1.71; 95% CI, 1.14-2.15).
• Male patients were more likely to achieve the ASDAS-LDA/ID response than female patients across all therapies (OR, 2.19; 95% CI, 1.47-3.26) and for both IL-17A and TNF inhibitors.

IN PRACTICE:

“Our findings underscore the significant influence of the patient sex on the response to advanced therapies in axSpA [axial spondyloarthritis]. Overall, females were less likely to achieve efficacy outcomes compared to male patients,” the authors wrote.

SOURCE:

This study was led by Angel Gao, Queen’s University, Kingston, Ontario, Canada, and was published online on February 24, 2src25, in Arthritis Care & Research.

LIMITATIONS:

The lack of sex-disaggregated data raised concerns regarding publication bias, with higher reporting in recent years possibly reflecting a growing awareness. This study lacked patient-level data, which may have prevented the investigation of potential underlying mechanisms such as concomitant medications or body mass index. The lack of sex-disaggregated safety data restricted the analysis of safety outcomes.

DISCLOSURES:

Three authors reported receiving educational and research grants, honoraria, or consultancy fees from various pharmaceutical companies. The corresponding author, Lihi Eder, was supported by the Canada Research Chair in Inflammatory Rheumatic Diseases.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.