RT Journal Article
SR Electronic
T1 Response to Tumor Necrosis Factor Inhibition in Male and Female Patients with Ankylosing Spondylitis: Data from a Swiss Cohort
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.170166
DO 10.3899/jrheum.170166
A1 Monika Hebeisen
A1 Regula Neuenschwander
A1 Almut Scherer
A1 Pascale Exer
A1 Ulrich Weber
A1 Giorgio Tamborrini
A1 Raphael Micheroli
A1 Lukas M.  Wildi
A1 Pascal Zufferey
A1 Michael J.  Nissen
A1 Peter M.  Villiger
A1 Jürg Bernhard
A1 Axel Finckh
A1 Irene E.  van der Horst-Bruinsma
A1 Joachim Sieper
A1 Robert Landewé
A1 Désirée van der Heijde
A1 Adrian Ciurea
YR 2018
UL http://www.jrheum.org/content/early/2018/02/08/jrheum.170166.abstract
AB Objective To investigate sex differences in connection with the effectiveness of tumor necrosis factor inhibitors (TNFi) in patients with ankylosing spondylitis (AS). Methods A total of 440 patients with AS (294 men; 146 women) initiating a first TNFi in the prospective Swiss Clinical Quality Management Cohort were included. We evaluated the proportion of patients achieving the 20% and 40% improvement in the Assessment of Spondyloarthritis international Society criteria (ASAS20 and ASAS40) as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) improvement and status scores at 1 year. Patients having discontinued TNFi were considered nonresponders. Logistic regression analyses were performed to adjust for important predictors of response. Results Compared to men, female patients had lower mean C-reactive protein levels, better spinal mobility, and more peripheral disease at the start. There was no sex disparity with regard to the ASDAS, the Bath Ankylosing Spondylitis Disease Activity and Functional indices, and the quality of life. At 1 year, 52% of women and 63% of men achieved an ASAS20 response (OR 0.63, 95% CI 0.37–1.07, p = 0.09). An inactive disease status (ASDAS < 1.3) was reached by 18% of women and 26% of men (OR 0.65, 95% CI 0.32–1.27, p = 0.22). These sex differences in response to TNFi were more pronounced in adjusted analyses (OR 0.34, 95% CI 0.16–0.71, p = 0.005 for ASAS20 and OR 0.10, 95% CI 0.03–0.31, p < 0.001 for ASDAS < 1.3) and confirmed for all the other outcomes assessed. Conclusion In AS, fewer women respond to TNFi and women show a reduced response in comparison to men.