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Research ArticlePsoriatic Arthritis
Open Access

Potential Impact of Sex and BMI on Response to Therapy in Psoriatic Arthritis: Post Hoc Analysis of Results From the SEAM-PsA Trial

Philip J. Mease, Dafna D. Gladman, Joseph F. Merola, Atul Deodhar, Alexis Ogdie, David H. Collier, Lyrica Liu and Arthur Kavanaugh
The Journal of Rheumatology August 2022, 49 (8) 885-893; DOI: https://doi.org/10.3899/jrheum.211037
Philip J. Mease
1P.J. Mease, MD, Director of Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health, Seattle, Washington, and Clinical Professor, University of Washington, Seattle, Washington, USA;
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Dafna D. Gladman
2D.D. Gladman, MD, FRCPC, Professor of Medicine, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada;
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Joseph F. Merola
3J.F. Merola, MD, Assistant Professor, Department of Dermatology and Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA;
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Atul Deodhar
4A. Deodhar, MD, MRCP, Professor of Medicine and Medical Director of Rheumatology Clinics, Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA;
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Alexis Ogdie
5A. Ogdie, MD, Associate Professor of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
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David H. Collier
6D.H. Collier, MD, Clinical Research Medical Director, Clinical Development, Amgen Inc., Thousand Oaks, California, USA;
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Lyrica Liu
7L. Liu, PhD, Biostatistician, Global Biostatistics, Amgen Inc., Thousand Oaks, California, USA;
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Arthur Kavanaugh
8A. Kavanaugh, MD, Professor of Medicine, Division of Rheumatology, Allergy, and Immunology, University of California San Diego, La Jolla, California, USA.
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  • Figure 1.
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    Figure 1.

    (A) Effect of MTX monotherapy, ETN monotherapy, and MTX+ETN combination therapy on the percentage of patients achieving ACR20, MDA, VLDA at week 24 by sex, and (B) mean change in PASDAS from baseline to week 24 by sex. N = no. of patients in the full analysis set. Descriptive statistics were used to examine outcomes within each treatment arm. P values were estimated from the normal approximation and are nominal; only P values ≤ 0.05 are shown. ACR: American College of Rheumatology; ETN: etanercept; MDA: minimal disease activity; MTX: methotrexate ; PASDAS: Psoriatic Arthritis Disease Activity Score; SE: standard error; VLDA: very low disease activity.

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    Figure 2.

    Effect of MTX monotherapy, ETN monotherapy, and MTX+ETN combination therapy on MDA and PASDAS at week 24 by sex (modeling analyses). (A) Least squares estimate MDA at week 24. (B) Least squares estimate change in PASDAS from baseline to week 24. N = no. of patients in the full analysis set. The mean differences between BMI categories were estimated from the normal approximation. For MDA, treatment differences and P values for comparison with MTX monotherapy were based on logistic model adjusted for prior nonbiologic DMARD use, baseline BMI status (kg/m2; ≤ 30 or > 30), gender, and treatment*gender interaction term. For PASDAS change, treatment differences and P values for comparison with MTX monotherapy were based on ANCOVA model adjusted for prior nonbiologic DMARD use, baseline BMI status (≤ 30 or > 30), and treatment*gender interaction term. P values are for the treatment difference in ETN arms to MTX monotherapy for the difference of male vs female and are nominal with no adjustments for multiplicity. DMARD: disease-modifying antirheumatic drug; ETN: etanercept; MDA: minimal disease activity; MTX: methotrexate; PASDAS: Psoriatic Arthritis Disease Activity Score; SE: standard error.

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    Figure 3.

    Effect of MTX monotherapy, ETN monotherapy, and MTX+ETN combination therapy on ACR20, MDA, VLDA, PASDAS, and BSA at week 24 by BMI category (descriptive statistics). (A) Percentage of patients achieving ACR20, MDA, and VLDA at week 24. (B) Mean change in PASDAS from baseline to week 24. (C) Mean percentage of BSA improvement from baseline to week 24 in patients with baseline BSA ≥ 3%. (D) Mean percentage of BSA improvement from baseline to week 24 in patients with baseline BSA ≥ 10%. N = no. of patients in the full analysis set. Descriptive statistics were used to examine outcomes within each treatment arm. P values were estimated from the normal approximation and are nominal; only P values ≤ 0.05 are shown. ACR: American College of Rheumatology; BSA: body surface area; ETN: etanercept; MDA: minimal disease activity; MTX: methotrexate; PASDAS: Psoriatic Arthritis Disease Activity Score; SE: standard error; VLDA: very low disease activity.

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    Figure 4.

    Effect of MTX monotherapy, ETN monotherapy, and MTX+ETN combination therapy on sPGA score at week 24 by BMI category (descriptive statistics for baseline BSA ≥ 3% and modeling analyses for baseline BSA ≥ 10%). (A) Achieving an sPGA score of clear (0) or almost clear (1) at week 24 in patients with baseline BSA ≥ 3%. (B) Achieving an sPGA score of clear (0) or almost clear (1) at week 24 in patients with baseline BSA ≥ 10%. N = no. of patients in the full analysis set with BSA ≥ 3% or ≥ 10% at baseline. The mean differences between BMI categories were estimated from the normal approximation. Treatment differences and P values for comparison with MTX monotherapy were based on logistic model adjusted for prior nonbiologic DMARD use, baseline BMI status (kg/m2; ≤ 30 or > 30) and treatment*BMI status interaction term. P values are for the treatment difference in ETN arms to MTX monotherapy for the difference of BMI ≤ 30 vs > 30 and are nominal with no adjustments for multiplicity. BSA: body surface area; DMARD: disease-modifying antirheumatic drug; ETN: etanercept; MTX: methotrexate; SE: standard error; sPGA: static physician global assessment.

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    Table 1.

    Baseline disease activity by sex.

     MTX Monotherapy, N = 284ETN Monotherapy, N = 284MTX+ETN Combination Therapy, N = 283
     MaleFemaleP, Male vs Femalea,bMaleFemaleP, Male vs Femalea,bMaleFemaleP, Male vs Femalea,b
    PsA duration, yrs3.8 (0.7)3.6 (0.6)–3.8 (0.6)2.3 (0.5)–3.1 (0.5)2.8 (0.6)–
    SJC6614.1 (1.1)12.0 (0.6)–11.7 (0.8)11.3 (0.8)–9.8 (0.6)12.7 (0.9)0.008
    TJC6820.4 (1.5)21.3 (1.1)–18.4 (1.2)19.4 (1.3)–17.4 (1.1)22.7 (1.4)0.004
    PGA, 0–10057.0 (1.8)59.8 (1.5)–57.5 (1.6)59.3 (1.4)–56.1 (1.4)59.9 (1.6)–
    CRP, mg/L10.9 (1.5)10.2 (1.2)–11.3 (1.4)10.1 (1.1)–7.8 (0.8)9.6 (1.2)–
    SPARCC enthesitis3.2 (0.4)4.4 (0.4)0.033.4 (0.3)4.0 (0.4)–3.5 (0.3)4.8 (0.4)0.02
    sPGA2.6 (0.1)2.6 (0.1)–2.7 (0.1)2.5 (0.1)–2.6 (0.1)2.4 (0.1)–
    sPGA status, n (%)
       < 222 (7.7)26 (9.2)–16 (5.6)24 (8.5)–22 (7.8)30 (10.6)–
       ≥ 2101 (35.6)132 (46.5)–135 (47.5)109 (38.4)–122 (43.1)109 (38.5)–
    BSA, %14.4 (1.8)11.3 (1.4)0.0412.0 (1.3)9.4 (1.2)–11.6 (1.4)9.8 (1.2)–
    BSA
       < 3%, n (%)40 (14.1)52 (18.3)–51 (18.0)54 (19.0)–51 (18.0)55 (19.4)–
       ≥ 3%, n (%)84 (29.6)108 (38.0)–100 (35.2)79 (27.8)–93 (32.9)84 (29.7)–
    HAQ-DI1.1 (0.1)1.4 (0.1)< 0.00011.0 (0.1)1.3 (0.1)0.00011.0 (0.1)1.3 (0.1)< 0.0001
    PtGA, 0–10057.3 (2.0)63.3 (1.8)0.0261.9 (1.9)64.1 (1.8)–57.9 (1.7)64.1 (1.8)0.01
    PtGAJP, 0–10053.6 (1.8)58.0 (1.8)–53.9 (1.9)59.4 (1.8)0.0451.9 (1.7)59.5 (1.9)0.003
    SF-36 PCS36.9 (0.8)34.6 (0.6)0.0238.4 (0.7)37.2 (0.7)–39.5 (0.8)35.2 (0.8)0.0001
    SF-36 MCS47.1 (1.1)43.7 (1.00)0.0246.2 (1.0)43.9 (1.1)–47.7 (0.9)44.8 (1.0)0.03
    • Values are expressed as mean (SE) unless otherwise stated.

    • ↵aP values are nominal.

    • ↵bOnly P values ≤ 0.05 are shown. BSA: body surface area; CRP: C-reactive protein; ETN: etanercept; HAQ-DI: Health Assessment Questionnaire-Disability Index; MTX: methotrexate; MCS: Mental Component Summary; PCS: Physical Component Summary ; PGA: physician global assessment; PsA: psoriatic arthritis; PtGA: patient global assessment of disease activity; PtGAJP: patient global assessment of joint pain; SE: standard error; SF-36: 36-item Short Form Health Survey; SJC66: swollen joint count in 66 joints; SPARCC: Spondyloarthritis Research Consortium of Canada; sPGA: static physician global assessment (of psoriasis); TJC68: tender joint count in 68 joints.

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    Table 2.

    Baseline disease activity by BMI (kg/m2).

     MTX Monotherapy, N = 284ETN Monotherapy, N = 284MTX+ETN Combination Therapy, N = 283
     BMI, ≤ 30BMI, > 30Pa,b, BMI ≤ 30 vs > 30BMI, ≤ 30BMI, > 30Pa,b, BMI ≤ 30 vs > 30BMI, ≤ 30BMI, > 30Pa,b, BMI ≤ 30 vs > 30
    PsA duration, yrs3.9 (0.6)3.4 (0.6)–2.8 (0.4)3.5 (0.7)–3.9 (0.6)1.9 (0.4)0.01
    SJC6611.1 (0.7)14.9 (0.9)0.00111.2 (0.7)11.9 (1.0)–10.1 (0.6)12.7 (1.0)0.02
    TJC6818.4 (1.2)23.6 (1.3)0.00317.3 (1.1)20.7 (1.3)–18.0 (1.1)22.6 (1.5)0.01
    PGA, 0–10057.1 (1.6)60.2 (1.7)–58.2 (1.5)58.7 (1.6)–56.6 (1.4)59.8 (1.6)–
    CRP, mg/L9.6 (1.4)11.5 (1.3)–10.5 (1.5)11.1 (1.1)–8.0 (1.0)9.6 (0.9)–
    SPARCC enthesitis3.3 (0.3)4.4 (0.4)0.033.6 (0.3)3.8 (0.4)–3.6 (0.3)4.8 (0.4)0.04
    sPGA2.5 (0.1)2.7 (0.1)–2.5 (0.1)2.8 (0.1)0.022.5 (0.1)2.5 (0.1)–
    sPGA status
       < 2, n (%)24 (8.5)24 (8.5)25 (8.8)15 (5.3)27 (9.5)25 (8.8)
       ≥ 2, n (%)120 (42.3)113 (39.8)–128 (45.1)116 (40.8)–133 (47.0)98 (34.6)–
    BSA, %12.3 (1.5)13.1 (1.7)–10.9 (1.2)10.4 (1.2)–10.2 (1.1)11.5 (1.6)–
    BSA
       < 3%, n (%)42 (14.8)50 (17.6)–58 (20.4)47 (16.5)–62 (21.9)44 (15.5)–
       ≥ 3%, n (%)104 (36.6)88 (31.0)–95 (33.5)84 (29.6)–98 (34.6)79 (27.9)–
    HAQ-DI1.2 (0.1)1.4 (0.1)0.031.1 (0.1)1.3 (0.1)0.0031.1 (0.1)1.3 (0.1)0.002
    PtGA, 0–10058.3 (2.0)63.2 (1.7)–63.2 (1.9)62.6 (1.8)–61.0 (1.7)60.9 (1.8)–
    PtGAJP, 0–10054.9 (1.8)57.4 (1.8)–55.0 (1.9)58.3 (1.8)–55.0 (1.8)56.5 (1.8)–
    SF-36 PCS37.1 (0.7)33.9 (0.7)0.00138.7 (0.7)36.7 (0.7)0.0438.3 (0.7)36.2 (0.8)–
    SF-36 MCS45.6 (1.0)44.7 (1.1)–46.1 (1.0)44.0 (1.1)–45.3 (0.9)47.5 (1.0)–
    • Values are expressed as mean (SE) unless otherwise stated.

    • ↵aP values are nominal.

    • ↵bOnly P values ≥ 0.05 are shown. BSA: body surface area; CRP: C-reactive protein; ETN: etanercept; HAQ-DI, Health Assessment Questionnaire-Disability Index; MCS: Mental Component Summary; MTX: methotrexate; PCS: Physical Component Summary; PGA: physician global assessment; PsA: psoriatic arthritis; PtGA: patient global assessment of disease activity; PtGAJP: patient global assessment of joint pain; SE: standard error; SF-36: 36-item Short Form Health Survey; SJC66: swollen joint count in 66 joints; SPARCC: Spondyloarthritis Research Consortium of Canada; sPGA: static physician global assessment (of psoriasis); TJC68: tender joint count in 68 joints.

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Potential Impact of Sex and BMI on Response to Therapy in Psoriatic Arthritis: Post Hoc Analysis of Results From the SEAM-PsA Trial
Philip J. Mease, Dafna D. Gladman, Joseph F. Merola, Atul Deodhar, Alexis Ogdie, David H. Collier, Lyrica Liu, Arthur Kavanaugh
The Journal of Rheumatology Aug 2022, 49 (8) 885-893; DOI: 10.3899/jrheum.211037

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Potential Impact of Sex and BMI on Response to Therapy in Psoriatic Arthritis: Post Hoc Analysis of Results From the SEAM-PsA Trial
Philip J. Mease, Dafna D. Gladman, Joseph F. Merola, Atul Deodhar, Alexis Ogdie, David H. Collier, Lyrica Liu, Arthur Kavanaugh
The Journal of Rheumatology Aug 2022, 49 (8) 885-893; DOI: 10.3899/jrheum.211037
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Keywords

BODY MASS INDEX
ETANERCEPT
METHOTREXATE
PSORIATIC ARTHRITIS
SEX

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