Gender differences in biologic treatment outcomes—a study of 1750 patients with psoriatic arthritis using Danish Health Care Registers

Højgaard, Pil; Ballegaard, Christine; Cordtz, René; Zobbe, Kristian; Clausen, Marianne; Glintborg, Bente; Kristensen, Lars Erik; Dreyer, Lene

doi:10.1093/rheumatology/key140

Cited by 67 publications

(77 citation statements)

References 46 publications

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“…Confounding by indication was possible; disease severity was generally mild in all cohorts and was within the same range across existing and initiated therapy, but some differences were seen for prior csDMARD use. Previous registry studies provided similar results but were conducted either outside the United States [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] or they used a subset of PsA patients from a registry in the United States that was designed primarily for patients with rheumatoid arthritis [40][41][42][43]. Our study used data from a registry in the United States that was specifically designed to collect information about patients with PsA.…”

Section: Discussionmentioning

confidence: 95%

Persistence of tumor necrosis factor inhibitor or conventional synthetic disease-modifying antirheumatic drug monotherapy or combination therapy in psoriatic arthritis in a real-world setting

Mease

Accortt

Rebello³

et al. 2019

Rheumatol Int

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This study described treatment patterns in a psoriatic arthritis (PsA) patient registry for new or ongoing tumor necrosis factor inhibitor (TNFi) monotherapy, conventional synthetic disease-modifying antirheumatic drug (csDMARD) monotherapy, or TNFi/csDMARD combination therapy. This retrospective analysis included adults with PsA who enrolled in the Corrona PsA/ spondyloarthritis registry between March 21, 2013 (registry initiation), and January 31, 2017, and received an approved TNFi and/or csDMARD as "existing use" starting before registry entry or "initiated use" starting on/after registry entry. Therapy persistence was defined as index therapy use for ≥ 12 months without a treatment gap of ≥ 30 days. Among the evaluable patients with existing TNFi monotherapy (n = 251), csDMARD monotherapy (n = 225), and combination therapy (n = 214), 93, 87, and 87% were persistent for ≥ 12 months, and another 6, 5, and 5%, respectively, had no change with < 12 months of follow-up after first use. Among evaluable patients who initiated use of TNFi monotherapy (n = 26), csDMARD monotherapy (n = 35), and combination therapy (n = 15), 50, 43, and 53% were persistent for ≥ 12 months, and another 27, 20, and 20%, respectively, had no change with < 12 months of follow-up after first use. After initiation of index therapy, most changes (19-27% of patients) were discontinuation; 4-13% switched biologic therapy during follow-up. The results of this analysis of real-world treatment patterns in a PsA patient registry suggest that nonpersistence for TNFi monotherapy, csDMARD monotherapy, or TNFi/csDMARD combination therapy occurs more commonly after initiation of therapy than in patients with existing therapy. Trial registration: NCT02530268.

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Section: Discussionmentioning

confidence: 95%

Persistence of tumor necrosis factor inhibitor or conventional synthetic disease-modifying antirheumatic drug monotherapy or combination therapy in psoriatic arthritis in a real-world setting

Mease

Accortt

Rebello³

et al. 2019

Rheumatol Int

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“…Consistent with findings from RA, some forms of spondyloarthritis (e.g., psoriatic arthritis), which are classified as autoinflammatory rather than autoimmune diseases, are more prevalent in females than males, with females having different disease manifestations (e.g., inflammatory bowel disease) that can delay diagnosis [24]. Data from observational cohort studies suggest that TNF inhibitors for psoriatic arthritis are more effective in male than female patients, even when controlling for confounding variables, including comorbidities (e.g., chronic pulmonary disease) and lifestyle (e.g., smoking) [25]. Females also are less likely than males to adhere to treatment with TNF inhibitors for spondyloarthritis, with lack of efficacy and adverse events being associated with immunotherapy withdrawal among females [24,26].…”

Section: Male-female Disparities In Immunotherapiesmentioning

confidence: 99%

The impact of sex and gender on immunotherapy outcomes

2020

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Immunotherapies are often used for the treatment, remission, and possible cure of autoimmune diseases, infectious diseases, and cancers. Empirical evidence illustrates that females and males differ in outcomes following the use of biologics for the treatment of autoimmune diseases, e.g., rheumatoid arthritis (RA), infectious diseases, e.g., influenza, and solid tumor cancers. Females tend to experience more adverse reactions than males following the use of a class of biologics referred to as immunotherapies. For immunotherapies aimed at stimulating an immune response, e.g., influenza vaccines, females develop greater responses and may experience greater efficacy than males. In contrast, for immunotherapies that repress an immune response, e.g., tumor necrosis factor (TNF) inhibitors for RA or checkpoint inhibitors for melanoma, the efficacy is reportedly greater for males than females. Despite these differences, discrepancies in reporting differences between females and males exist, with females have been historically excluded from biomedical and clinical studies. There is a critical need for research that addresses the biological (i.e., sex) as well as sociocultural (i.e., gender) causes of male-female disparities in immunotherapy responses, toxicities, and outcomes. One-size-fits-all approaches to immunotherapies will not work, and sex/gender may contribute to variable treatment success, including adherence, in clinical settings.

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“…Nonetheless, sex‐related differences have been observed in the clinical phenotypes of psoriatic arthritis. Men are more likely to develop axial disease and radiographic joint damage, while women are more likely to develop severe limitation in function and respond less favourably to tumour necrosis factor‐α (TNF‐α) inhibitor treatment …”

Section: Psoriatic Arthritismentioning

confidence: 99%

Beyond skin deep: addressing comorbidities in psoriasis

Kovitwanichkanont

Chong

Foley

2020

Medical Journal of Australia

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Summary Psoriasis is a chronic inflammatory disease that is commonly encountered in primary care and is associated with significant morbidity that extends beyond the skin manifestations. Psoriasis is associated with an elevated risk of psoriatic arthritis, cardiovascular disease, obesity, insulin resistance, mental health disorders, certain types of malignancy, inflammatory bowel disease and other immune‐related disorders, and hepatic and renal disease. Enhanced recognition of these comorbidities may lead to earlier diagnosis and potentially better overall health outcomes. Psoriatic nail involvement, severe skin disease and obesity are associated with a greater risk of psoriatic arthritis. Individuals with psoriasis should be routinely screened for psoriatic arthritis to allow for early intervention to improve long term prognosis. Life expectancy is reduced in people with psoriasis due to a variety of causes, with cardiovascular disease and malignancy being the most common aetiologies. Psoriasis affects several factors that contribute to worsened quality of life and increased risk of depression and anxiety. Effective therapies are now available that have been shown to concurrently improve skin disease, quality of life and psychiatric symptoms. As the concordance between psychosocial impact and objective disease severity does not always correlate, it is essential to tailor management strategies specifically to the needs of each individual. Cigarette smoking and excess alcohol consumption are among the most important modifiable risk factors that increase the likelihood of psoriasis development and severity of skin disease. This provides a compelling rationale for smoking cessation and limiting alcohol intake in people with psoriasis beyond their traditional harmful health consequences.

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Gender differences in biologic treatment outcomes—a study of 1750 patients with psoriatic arthritis using Danish Health Care Registers

Abstract: Male gender was strongly associated with greater TNFI treatment effectiveness. Adjustment for baseline risk factors including patient-reported outcomes, disease activity, comorbidities and lifestyle factors did not influence this relationship, which suggests a role of biological factors.

Cited by 67 publications

References 46 publications

Persistence of tumor necrosis factor inhibitor or conventional synthetic disease-modifying antirheumatic drug monotherapy or combination therapy in psoriatic arthritis in a real-world setting

Persistence of tumor necrosis factor inhibitor or conventional synthetic disease-modifying antirheumatic drug monotherapy or combination therapy in psoriatic arthritis in a real-world setting

The impact of sex and gender on immunotherapy outcomes

Beyond skin deep: addressing comorbidities in psoriasis

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