Gender Disparities in the Management of Rheumatoid Arthritis in the US: A Real-World Evidence Study

OBJECTIVES: The study aims to assess gender-based disparities in the management of rheumatoid arthritis (RA), focusing on the influence of gender on the effectiveness of disease-modifying antirheumatic drugs (DMARDs). Additionally, it seeks to analyze patient phenotypes based on observed treatment differences.

METHODS: This retrospective cohort study utilizes Optum's Market Clarity integrated administrative claims and EHR database to identify patients (age >= 18 years) diagnosed with RA using ICD-10 CM codes between October 1, 2016, and December 31, 2018, with no previous diagnosis within the preceding year. Patients prescribed pharmacotherapy, including methotrexate (MTX) monotherapy, conventional synthetic DMARDs (csDMARDs) excluding MTX, MTX combination therapy with other csDMARDs, biologic DMARDs (bDMARDs) with or without other csDMARDs, or targeted synthetic DMARDs (tsDMARDs) with or without other csDMARDs, are included. The study assesses the three-year duration of pharmacotherapy and treatment line changes following the index date for patients diagnosed with RA. Patient phenotypes are identified through the analysis of data and natural language processing (NLP) notes, incorporating biomarkers, serological factors, and genetic factors.

RESULTS: Initial analysis reveals that MTX monotherapy was prescribed as the first-line treatment for 39.55% of males and 33.36% of females. Similarly, csDMARDs excluding MTX were prescribed to 49.75% of females and 37.28% of males. Disparities also exist in the utilization of bDMARDs, with 13.75% of females and 20.45% of males receiving this treatment. Chi-square tests were conducted, revealing significant differences (p<0.001) between males and females in terms of first-line therapy.

CONCLUSIONS: This study contributes to a better understanding of gender disparities in the management of rheumatoid arthritis, with the potential to inform and improve care delivery for both male and female RA patients. By incorporating these findings into clinical practice, healthcare professionals can optimize treatment strategies, enhance patient outcomes, and advance towards more tailored and effective therapies for individuals with RA.