Gender difference in disease severity and treatment outcomes among patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) starting treatment with targeted therapies in the Czech Republic − analysis from the nation-wide ATTRA registry of biological therapy
Authors:
J. Závada 1,2; L. Nekvindová 3,4
Authors‘ workplace:
Revmatologický ústav, Praha
1; Klinika revmatologie 1. LF UK, Praha
2; Institut biostatistiky a analýz, s. r. o., spin-off společnost Masarykovy univerzity, Brno
3; 1. LF UK, Praha
4
Published in:
Čes. Revmatol., 29, 2021, No. 4, p. 181-188.
Category:
- analýza z národního registru biologické léčby ATTRA
Overview
Introduction: The ATTRA registry captures more than 95% of patients with RA, AxSpA, or PsA treated with biologics in the Czech Republic (CZ).
Objectives: We aimed to investigate gender-related differences in baseline characteristics and treatment effectiveness among patients with RA, AxSpa, and PsA starting first targeted therapy (TT) in CZ.
Methods: In this observational cohort study, the ATTRA registry provided prospectively collected data on RA, AxSpA, and PsA patients who initiated their first TT (mostly by TNFi) in 2012–6/2018. Treatment effectiveness was assessed at 12 months by a change in patient-reported outcomes (PROs), CRP, and % drug survival. Differences in categorical and continuous data btw males and females were assessed using the Pearson χ2-test (of Fisher exact test, as appropriate), or Mann-Whitney test respectively. This study was primarily descriptive, and no statistical adjustments have been made.
Results: A total of 1602 RA, 1306 AxSpA, and 493 PsA patients were included. When starting their first TT, males tended to have higher levels of CRP, while females were more often (ex)smokers and reported worse parameters of quality of life across the diagnostic groups. The improvement of PROs was similar in males and females, while males with axSpA and PsA showed larger improvements in CRP.
Conclusions: Targeted therapy had a similar effect on the quality of life in females and males with RA, AxSpA, and PsA after one year of follow-up.
Keywords:
registry – Quality of life – Psoriatic arthritis – biological therapy – rheumatoid arthritis – axial spondyloarthritis
Sources
1. Myasoedova E, Crowson CS, Kremers HM, Therneau TM, Gabriel SE. Is the incidence of rheumatoid arthritis rising? Results from Olmsted County, Minnesota, 1955–2007. Arthritis Rheum 2010; 62(6): 1576–1582. doi: 10.1002/art.27425
2. Jawaheer D, Maranian P, Park G, Lahiff M, Amjadi SS, Paulus HE. Disease progression and treatment responses in a prospective DMARD-naive seropositive early rheumatoid arthritis cohort: does gender matter? J Rheumatol 2010; 37(12): 2475–2485. doi: 10.3899/jrheum.091432
3. Jawaheer D, Olsen J, Hetland ML. Sex differences in response to anti-tumor necrosis factor therapy in early and established rheumatoid arthritis: results from the DANBIO registry. J Rheumatol 2012; 39(1): 46–53. doi: 10.3899/jrheum.110548
4. Forslind K, Hafstrom I, Ahlmen M, Svensson B. Sex: a major predictor of remission in early rheumatoid arthritis? Ann Rheum Dis 2007; 66(1): 46–52. doi: 10.1136/ard.2006.056937
5. Hyrich KL, Watson KD, Silman AJ, Symmons DP. Predictors of response to anti-TNF-alpha therapy among patients with rheumatoid arthritis: results from the British society for rheumatology biologics register. Rheumatol (Oxford) 2006; 45(12): 1558– 1565. doi:10.1093/rheumatology/kel149
6. Jawaheer D, Messing S, Reed G, Ranganath VK, Kremer JM, Louie JS, Khanna D, Greenberg JD, Furst DE. Significance of sex in achieving sustained remission in the consortium of rheumatology researchers of North America cohort of rheumatoid arthritis patients. Arthritis Care Res (Hoboken) 2012; 64(12): 1811– 1818. doi: 10.1002/acr.21762
7. Rudwaleit M, van der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J, et al. The development of assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009; 68(6): 777–783.
8. Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT, et al. The assessment of SpondyloArthritis International Society classification criteria for peripheral spon- dyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011; 70(1): 25–31.
9. Hill HF, Hill AG, Bodmer JG. Clinical diagnosis of ankylosing spondylitis in women and relation to presence of HLA-B27. Ann Rheum Dis 1976; 35(3): 267–270.
10.Gran JT, Ostensen M, Husby G. A clinical comparison between males and females with ankylosing spondylitis. J Rheumatol 1985; 12(1): 126–129.
11. Kennedy LG, Will R, Calin A. Sex ratio in the spondyloarthropathies and its relationship to phenotypic expression, mode of inheritance and age at onset. J Rheumatol 1993; 20(11): 1900–1904.
12. Calin A, Elswood J, Rigg S, Skevington SM. Ankylosing spondylitis – an analytical review of 1500 patients: the changing pattern of disease. J Rheumatol 1988; 15(8): 1234–1238.
13. Will R, Edmunds L, Elswood J, Calin A. Is there sexual inequality in ankylosing spondylitis? A study of 498 women and 1202 men. J Rheumatol 1990; 17(12): 1649–1652.
14. van den Berg R, van Gaalen F, van der Helm-van Mil A, Huizinga T, van der Heijde D. Performance of classification criteria for peripheral spondyloarthritis and psoriatic arthritis in the Leiden early arthritis cohort. Ann Rheum Dis 2012; 71(8): 1366–1369.
15. Sieper J, van der Heijde D. Review: Nonradiographic axial spondyloarthritis: new definition of an old disease? Arthritis Rheum 2013; 65(3): 543–551.
16. Gremese E, Bernardi S, Bonazza S, Nowik M, Peluso G, Massara A, et al. Body weight, gender and response to TNF-alpha blockers in axial spondyloarthritis. Rheumatology (Oxford) 2014; 53(5): 875–881.
17. Shbeeb M, Uramoto KM, Gibson LE, O'Fallon WM, Gabriel SE. The epidemiology of psoriatic arthritis in Olmsted County, Minnesota, USA, 1982–1991. J Rheumatol 2000; 27: 1247–1250.
18. Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005; 64(Suppl 2): ii14–17.
19. Gladman DD, Brubacher B, Buskila D, Langevitz P, Farewell VT. Psoriatic spondyloarthropathy in men and women: a clinical, radiographic, and HLA study. Clin Invest Med 1992; 15: 371–375.
20. Queiro R, Sarasqueta C, Torre JC, Tinture T, Lopez-Lagunas Comparative analysis of psoriatic spondyloarthropathy between men and women. Rheumatol Int 2001; 21: 66–68.
21. Váňová A, Skývová M, Malý M. Státní zdravotní ústav 2018. http://www.szu.cz/uploads/documents/szu/aktual/uzivani_ tabaku_2017.pdf
22. Sugiyama D, Nishimura K, Tamaki K, Tsuji G, Nakazawa T, Morinobu A, Kumagai S. Impact of smoking as a risk factor for developing rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis 2010; 69(1): 70–81. doi: 10.1136/ ard.2008.096487
23. Vittecoq O, Richard L, Banse C, Lequerré T. The impact of smoking on rheumatoid arthritis outcomes. Joint Bone Spine 2018; 85(2): 135–138. doi: 10.1016/j.jbspin.2017.12.004
24. Mattey DL, Dawson SR, Healey EL, Packham JC. Relationship between smoking and patient-reported measures of disease outcome in ankylosing spondylitis. J Rheumatol 2011; 38: 2608–2615.
25. Chung HY, Machado P, van der Heijde D, D'Agostino MA, Dougados M. Smokers in early axial spondyloarthritis have earlier disease onset, more disease activity, inflammation and damage, and poorer function and health-related quality of life: results from the DESIR cohort. Ann Rheum Dis 2012; 71: 809–816.
26. Pezzolo E, Naldi L. The relationship between smoking, psoriasis and psoriatic arthritis. Expert Rev Clin Immunol 2019; 15(1): 41–48.
27. Krishnan E, Sokka T, Hannonen P. Smoking-gender interaction and risk for rheumatoid arthritis. Arthritis Res Ther 2003; 5(3): R158–162. doi: 10.1186/ar750
28. Krishnan E. Smoking, gender and rheumatoid arthritis-epidemiological clues to etiology. Results from the behavioral risk factor surveillance system. Joint Bone Spine 2003; 70(6): 496–502.
29. Unruh AM. Gender variations in clinical pain experience. Pain 1996; 65: 123–167.
30. van den Ende CH, Hazes JM, Le Cessie S, et al. Discordance between objective and subjective assessment of functional abi- lity of patients with rheumatoid arthritis. Br J Rheumatol 1995; 34: 951–955.
31. Häkkinen A, Kautiainen H, Hannonen P, et al. Muscle strength, pain, and disease activity explain individual subdimensions of the Health Assessment Questionnaire disability index, especially in women with rheumatoid arthritis. Ann Rheum Dis 2006; 65: 30–34.
32. Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA 1999; 282(22): 2131–2135.
33. Rubio Vargas R, van den Berg R, van Lunteren M, Ez-Zaitouni Z, Bakker PA, Dagfinrud H, et al. Does body mass index (BMI) influence the ankylosing spondylitis disease activity score in axial spondyloarthritis?: data from the SPACE cohort. RMD Open 2016; 2(1): e000283.
34. Webers C, Essers I, Ramiro S, Stolwijk C, Landewe R, van der Heijde D, et al. Gender-attributable differences in outcome of ankylosing spondylitis: long-term results from the outcome in ankylosing spondylitis international study. Rheumatology (Oxford) 2016; 55(3): 419–428. [PubMed] [Google Scholar].
35. Ramiro S, Stolwijk C, van Tubergen A, van der Heijde D, Dougados M, van den Bosch F, et al. Evolution of radiographic damage in ankylosing spondylitis: a 12 year prospective follow-up of the OASIS study. Ann Rheum Dis 2015; 74(1): 52–59.
36. Højgaard P, Ballegaard C, Cordtz R, Zobbe K, Clausen M, Glintborg B, Kristensen LE, Dreyer L. Gender differences in bio- logic treatment outcomes-a study of 1750 patients with psoriatic arthritis using Danish Health Care Registers Rheumatology (Oxford) 2018; 57(9): 1651–1660.
37. Eder L, Thavaneswaran A, Chandran V, Gladman DD. Gender difference in disease expression, radiographic damage and disability among patients with psoriatic arthritis. Ann Rheum Dis 2013; 72(4): 578–582.
38. Hekmat K, Jacobsson LT, Nilsson JÅ, Lindroth Y, Turesson C. Changes and sex differences in patient reported outcomes in rheumatoid factor positive RA-results from a community based study. BMC Musculoskelet Disord 2014; 15: 44.
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Dermatology & STDs Paediatric rheumatology RheumatologyArticle was published in
Czech Rheumatology
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