The Sex Influence on Response to Tumor Necrosis Factor-α Inhibitors and Remission in Axial Spondyloarthritis.

J Rheumatol

From the Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio, " Università degli Studi del Molise, Campobasso; Day Hospital of Rheumatology, Azienda Sistema Socio Sanitario (ASST) Centro Specialistico Ortopedico Traumatologico G. Pini-Centro Specialistico Traumatologico-Ortopedico (CTO), Milan; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; La Struttura Semplice Dipartimentale (SSD) di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna, Bologna; Rheumatology Unit, Department of Clinical and Experimental Medicine (DIMED), University of Padua, Padua; Rheumatology Unit, Azienda Ospedaliera-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy. Supported by the Gruppo di Studio Spondiloartriti e Artropatia Psoriasica - Antonio Spadaro. All authors are members of this group. E. Lubrano, MD, PhD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio, " Università degli Studi del Molise; F.M. Perrotta, MD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio, " Università degli Studi del Molise; M. Manara, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO; S. D'Angelo, MD, PhD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; O. Addimanda, MD, PhD, SSD di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna; R. Ramonda, MD, PhD, Rheumatology Unit, DIMED, University of Padua; L. Punzi, MD, PhD, Rheumatology Unit, DIMED, University of Padua; I. Olivieri, MD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; C. Salvarani, MD, IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia; A. Marchesoni, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO. Dr. Ignazio Olivieri died July 28, 2017. Address correspondence to Dr. E. Lubrano, Dipartimento di Medicina e di Scienze della Salute "Vincenzo Tiberio, " Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100 Campobasso, Italy. E-mail: Accepted for publication September 12, 2017.

Published: November 2017

Objective: The aim of this study was to evaluate the influence of sex on response to treatment and disease remission in patients with axial spondyloarthritis (axSpA).

Methods: In this retrospective multicenter study, patients with axSpA, according to the Assessment of Spondyloarthritis international Society (ASAS) criteria for axSpA, and treated with adalimumab, etanercept, golimumab, or infliximab, were studied. We compared clinical characteristics, patient-reported outcomes, disease activity, function, and response to treatment in male and female patients with this disease.

Results: Three hundred forty patients with axSpA (270 with ankylosing spondylitis, 19 with psoriatic arthritis with axial involvement, and 51 with nonradiographic axSpA) were studied. Male subjects had a significantly higher prevalence of grade IV sacroiliitis, higher levels of serum C-reactive protein, lower Maastricht Ankylosing Spondylitis Enthesitis Score, and fatigue when compared with females. Further, Kaplan-Meier survival curves showed that the rate of partial remission, ASAS40 response, and Ankylosing Spondylitis Disease Activity Score (ASDAS) major improvement, but not ASDAS inactive disease, were significantly lower in female patients.

Conclusion: Our data suggest that female sex was associated with a lower rate of response to treatment and of disease remission in patients with axSpA treated with antitumor necrosis factor-α drugs.

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http://dx.doi.org/10.3899/jrheum.17666DOI Listing

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