Is there a sex bias in prescribing anti-tumour necrosis factor medications to patients with rheumatoid arthritis? A nation-wide cross-sectional study

Arkema, Elizabeth V.; Neovius, Martin; Joelsson, Joel; Vollenhoven, Ronald F. van

doi:10.1136/annrheumdis-2011-200947

Cited by 21 publications

(22 citation statements)

References 17 publications

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“…However, we did not find such evidence, and this is in line with similar studies [39]. The differences in TJC and SJC are not large, they could nonetheless be important when studied at group level.…”

Section: Discussionsupporting

confidence: 89%

Gender and the treatment of immune-mediated chronic inflammatory diseases: rheumatoid arthritis, inflammatory bowel disease and psoriasis: an observational study

Lesuis

Befrits

Nyberg

et al. 2012

BMC Med

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BackgroundRheumatoid arthritis (RA), inflammatory bowel disease (IBD), and psoriasis are immune-mediated inflammatory diseases with similarities in pathophysiology, and all can be treated with similar biological agents. Previous studies have shown that there are gender differences with regard to disease characteristics in RA and IBD, with women generally having worse scores on pain and quality of life measurements. The relationship is less clear for psoriasis. Because treatment differences between men and women could explain the dissimilarities, we investigated gender differences in the disease characteristics before treatment initiation and in the biologic treatment prescribed.MethodsData on patients with RA or IBD were collected from two registries in which patients treated with biologic medication were enrolled. Basic demographic data and disease activity parameters were collected from a time point just before the initiation of the biologic treatment. For patients with psoriasis, the data were taken from the 2010 annual report of the Swedish Psoriasis Register for systemic treatment, which included also non-biologic treatment. For all three diseases, the prescribed treatment and disease characteristics were compared between men and women.ResultsIn total, 4493 adult patients were included in the study (1912 with RA, 131 with IBD, and 2450 with psoriasis). Most of the treated patients with RA were women, whereas most of the patients with IBD or psoriasis were men. There were no significant differences between men and women in the choice of biologics. At treatment start, significant gender differences were seen in the subjective disease measurements for both RA and psoriasis, with women having higher (that is, worse) scores than men. No differences in objective measurements were found for RA, but for psoriasis men had higher (that is, worse) scores for objective disease activity measures. A similar trend to RA was seen in IBD.ConclusionsWomen with RA or psoriasis scored significantly higher on subjective, but not on objective, disease activity measures than men, and the same trend was seen in IBD. This indicates that at the same level of treatment, the disease has a greater effect in women. These findings might suggest that in all three diseases, subjective measures are discounted to some extent in the therapeutic decision-making process, which could indicate undertreatment in female patients.

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Section: Discussionsupporting

confidence: 89%

Gender and the treatment of immune-mediated chronic inflammatory diseases: rheumatoid arthritis, inflammatory bowel disease and psoriasis: an observational study

Lesuis

Befrits

Nyberg

et al. 2012

BMC Med

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“…This is in line with other European registries in the PsoNet group, showing a notable dominance of men with 68% in the Netherlands, 67% in Italy, 66% in Denmark, 63% in Spain and 60% in Germany [10]. There is an active discussion whether women are discriminated by not receiving the same quantity of high-priced drugs as men in several fields of medicine [11], [12]. Previous studies indicate that men receive systemic or UV treatment for psoriasis in greater extent than women [13], [14].…”

Section: Introductionsupporting

confidence: 85%

The Higher Proportion of Men with Psoriasis Treated with Biologics May Be Explained by More Severe Disease in Men

et al. 2013

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ObjectivesModerate to severe psoriasis, once regarded as merely a skin disease, is today seen as an inflammatory systemic disease. The sex ratio of the prevalence of psoriasis is balanced. In recent years several reports have documented that men receive more systemic or UV treatment than women, and different hypotheses were made. In PsoReg, the national registry for systemic treatment of psoriasis in Sweden, we have, like other European registries, observed a predominance of men (59%), especially of men treated with biologics (63%). Biologics are a relatively new group of very effective but high-priced drugs. The objective of this study was to analyse if women are discriminated by not having the same access to the high-priced biologics.DesignPopulation based cohort study using data from a nationwide quality register of psoriasis patients.Population2294 patients with moderate to severe psoriasis receiving systemic treatment from a specialist in dermatology.Main Outcome MeasuresTime to initiation of biologic treatment. A multiple Cox proportional hazard’s regression was performed, with time to initiating a biologic treatment as the outcome in order to assess the independent role of the patient’s sex in initiating such therapy. The psoriasis severity was defined as a time-varying variable.ResultsMen had more severe psoriasis than women according to the Psoriasis Area and Severity Index (PASI), regardless of age at enrolment, and throughout the study period. The analysis in the multiple Cox regression show that age, psoriasis severity and psoriasis arthropathy were relevant factors for initiating biologic therapy, whereas sex is not.ConclusionsAlthough as many women as men are believed to suffer from psoriasis, men seem to be more severely affected by psoriasis. The asymmetry in allocation of biologic therapy thereby probably reflects the differing disease activity between the sexes, and is not a discrimination against women per se.

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“…Thus, the only DAS28 component that significantly differed during the longitudinal analysis was the TJC. Previous studies in RA have shown higher disease activity in women as measured by the DAS28, TJC score and patient global assessment, [15][16][17] contrasting with similar radiographical progression. 4 16 Gender differences in pain perception and assessment reported in RA as well as in spondyloarthritis 18 19 may explain this dissociation.…”

Section: Discussionmentioning

confidence: 99%

Impact of gender on the response and tolerance to abatacept in patients with rheumatoid arthritis: results from the ‘ORA’ registry

Nourisson

Soubrier

Mulliez³

et al. 2017

RMD Open

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ObjectiveThe impact of gender on the response and tolerance to abatacept was assessed in a large prospective cohort during 2 years of follow-up.MethodsFrom the 1017 patients included in the Orencia and Rheumatoid Arthritis registry, disease activity was assessed at baseline, 6, 12 and 24 months. The relationship between the European League Against Rheumatism (EULAR) response, Disease Activity Score 28 (DAS28) remission, rate of adverse events and gender was explored in multivariate analysis.Results990 patients, 79.3%female, with at least one follow-up visit were analysed. At baseline, women had longer disease duration, higher disease activity and more often received antitumour necrosis factor (TNF) drugs. The remission was not different between men and women during the follow-up after adjustment on age, disease duration and activity, rheumatoid factor and anti-cyclic citrullinated pyeptide (CCP) positivity, and current disease-modifying antirheumatic drugs (DMARDs), previous TNF blockers and corticosteroids use. The proportion of men and women achieving EULAR good-or-moderate response at any endpoints was similar (52.4% vs 55.5%), as well as time to achieving EULAR response (5.4±4.9 vs 5.6±5.2 months). Moderate EULAR response was more frequent in women at 6 months (OR=1.80, p=0.02) but was no longer significant at 12 or 24 months. During the follow-up, the DAS28, the tender joint count score and the patient global assessment remained higher in women (p=0.001, 0.04 and 0.06, respectively). Drug retention and safety were comparable.ConclusionIn this large daily practice cohort of established rheumatoid arthritis treated with abatacept, women achieved similar remission and EULAR response than men despite higher disease activity and tender joint count during the treatment course.

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Is there a sex bias in prescribing anti-tumour necrosis factor medications to patients with rheumatoid arthritis? A nation-wide cross-sectional study

Cited by 21 publications

References 17 publications

Gender and the treatment of immune-mediated chronic inflammatory diseases: rheumatoid arthritis, inflammatory bowel disease and psoriasis: an observational study

Gender and the treatment of immune-mediated chronic inflammatory diseases: rheumatoid arthritis, inflammatory bowel disease and psoriasis: an observational study

The Higher Proportion of Men with Psoriasis Treated with Biologics May Be Explained by More Severe Disease in Men

Impact of gender on the response and tolerance to abatacept in patients with rheumatoid arthritis: results from the ‘ORA’ registry

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