Presentation (CTI)

OBJECTIVES: Substantial sex-based differences have been reported in disease manifestation, diagnostic delay, response to biologic therapy, and drug survival among patients with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). The study objective was to characterize and compare demographic, clinical, and treatment patterns between male and female patients with moderate to severe axSpA or PsA who are initiating TNF inhibitors (TNFi) in routine clinical practice.
METHODS: The study utilized clinical cohorts of U.S. patients managed by rheumatologists from the OM1 Rheumatology Network (OM1, Inc; Boston, MA), which includes deep clinical data, including laboratory, patient-reported, and disease activity information and linked medical and pharmacy claims starting from 2013. Inclusion criteria included diagnoses of ankylosing spondylitis (AS), non-radiographic and unspecified AxSpA, and PsA. Demographics, comorbidities/extra-articular manifestations, TNFi and other biologic DMARD use, and disease activity during follow-up were evaluated.
RESULTS: The study included 53,639 patients including 31,869 women (59%). Mean age at index (first TNFi record) was 51.6 years (SD 14.3), with a higher proportion of women age > 50 at TNFi start. Comorbidity burden was higher for women (overall, Charlson Comorbidity Index > 2, 14% v. 10%), and most notably for thyroid disorder (26.5% vs. 8.5%), fibromyalgia (24.3% v. 7.2%), depression (28.1% vs. 12.7%), anxiety (27.2% v. 13.2%), asthma (13.4% v. 5.4%), obesity (57.9% vs. 50.0%), and osteoporosis (9.8% vs. 2.4%). Of patients with index BASDAI, score ≥ 4 was more common in women (10% vs. 8%). Treatment duration, subsequent treatments, and indicators of disease severity were also evaluated.
CONCLUSIONS: Real-world data suggest that female patients with spondyloarthropathies are markedly different from male patients in ways that may have implications for optimizing care and managing pain-related outcomes.