Background/Purpose:

The prevalence of rheumatoid arthritis (RA) is 2-4 times higher in women compared to men depending on age. Furthermore, in women RA incidence increases from the age of menarche peaking around menopause, while it is rare in men under the age of 45 years (1). Several studies have shown that treatment outcomes are worse in women (2). This analysis examined gender-specific differences with respect to patient and disease parameters at initiation of the first anti-TNF agent for the treatment of RA in a Canadian routine clinical practice setting.

Methods:

BioTRAC is an ongoing Canadian registry of RA, AS or PsA patients initiating treatment with infliximab (IFX) or golimumab (GOL) as first biologics or after having been treated with a biologic for less than six months. This analysis is based on 781 biologic naive RA patients initiating infliximab treatment between 2002 and 2012.  

Results:

Among the 781 patients, 593 (75.9%) were female and 188 (24.1%) were male. Mean age and disease duration at initiation of infliximab treatment were comparable between groups.

Overall patient characteristics differed significantly between genders (Table 1). Mean morning (AM) stiffness, HAQ-DI, pain, patient global assessment of disease activity (PtGA), CDAI, and RAPID 3 were statistically significantly higher in female patients. Furthermore, a higher proportion of women were rheumatoid factor (RF) positive and unemployed. However, physician assessment of global disease activity (MDGA), TJC, SJC, CRP, DAS28-CRP, and SDAI were comparable between genders.

 

Table 1: Patient Characteristics at Baseline by Gender
Parameter Mean (SD)	Male (n=188)	Female (n=593)	P-Value
Age: years	54.3 (13.1)	55.6 (13.7)	0.228
Disease duration: years	7.9 (8.2)	9.0 (9.7)	0.557
AM stiffness: min	63.8 (44.2)	72.9 (43.4)	0.012
HAQ-DI	1.4 (0.7)	1.7 (0.7)	<0.001
Pain: VAS cm	5.4 (2.5)	5.9 (2.3)	0.019
CRP: mg/L	21.5 (27.8)	18.2 (22.7)	0.142
SJC-28	10.2 (7.4)	11.1 (6.9)	0.058
TJC-28	12.3 (8.5)	13.0 (7.9)	0.245
MDGA: VAS cm	6.3 (2.3)	6.6 (2)	0.137
PtGA: VAS cm	5.6 (2.6)	6.2 (2.3)	0.012
DAS28-CRP	5.2 (1.4 )	5.5 (1.3)	0.068
SDAI	36.4 (18.5)	39.3 (16.6)	0.056
CDAI	34.5 (17.5)	37.2 (15.8)	0.035
RAPID 3	15.6 (6.7)	17.7 (6.0)	<0.001
RF-positive: n (%)	112 (67.1%)	425 (76.6%)	0.028
Employed: n (%)	92 (49.2%)	184 (31.3)	<0.001

Conclusion:

Objective measures (SJC, TJC, MDGA, CRP) were similar for male and female patients at infliximab initiation. However, patient reported outcomes (HAQ-DI, Pain and PtGA) were worse at baseline for female patients at initiation of biologic treatment in this Canadian rheumatoid arthritis population.

References

1. Wilder RL. J Rheumatol Suppl. 1996 Mar;44:10-2.

2. Forslind K. et al. Ann Rheum Dis. 2007 Jan;66(1):46-52.

3. Tengstrand B. et al. J Rheumatol. 2004 Feb;31(2):214-22.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/are-there-gender-specific-differences-in-patient-characteristics-at-initiation-of-biologic-treatment-in-rheumatoid-arthritis/