Gender Differences in Psoriatic Arthritis – Impact on Tumor Necrosis Factor Inhibitors Persistence and Response

Elsa Vieira-Sousa¹, Mónica Eusébio ², Pedro Ávila-Ribeiro ³, Nikita Khmelinskii ⁴, Rita Cruz-Machado ⁵, Teresa Martins Rocha ⁶, Miguel Bernardes ⁷, Daniela Santos-Faria ⁸, Joana Leite Silva ⁸, Helena Santos ⁹, Cláudia Miguel ¹⁰, Pedro Carvalho ¹¹, Tiago Costa ¹², Lídia Teixeira ¹³, Tiago Meirinhos ¹⁴, Patrícia Nero ¹⁵, João Eurico Fonseca ³ and Maria José Santos ¹⁶, ¹Rheumatology and Metabolic Bone Diseases, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, EPE | Rheumatology Research Unit, Instituto de Medicina Molecular - Faculty of Medicine, University of Lisbon, Lisbon Academic Medical Centre, Lisbon, Portugal,, Lisbon, Portugal, ²Portuguese Society of Rheumatology, Lisbon, Portugal, ³Rheumatology and Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte; Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa; Centro Académico de Medicina de Lisboa; Lisbon, Portugal., Lisbon, Portugal, ⁴Rheumatology and Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte; Lisbon, Portugal., Lisbon, Portugal, ⁵Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHULN; Lisboa, Portugal. Centro Académico de Medicina de Lisboa, Portugal., Lisbon, Portugal, ⁶Rheumatology Department, Porto, Porto, Portugal, ⁷Rheumatology, Centro Hospitalar de São João, Porto, Portugal, Porto, Portugal, ⁸Rheumatology Department, ULSAM, Ponte de Lima, Portugal, ⁹Instituto Português de Reumatologia (IPR), Lisbon, Portugal, ¹⁰Instituto Português de Reumatologia, Lisbon, Portugal, ¹¹Rheumatology Department, CHUC and CHUA, Faro, Portugal, ¹²Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental; CEDOC, NOVA Medical School, Faculdade de Ciências Médicas, Lisbon., Lisbon, Portugal, ¹³Rheumatology Department, HGO, Almada, Portugal, ¹⁴Rheumatology Department, CHBV, Aveiro, Portugal, ¹⁵Hospital CUF Descobertas, Lisbon, Portugal, ¹⁶Rheumatology department, Hospital Garcia de Orta, Almada, Portugal

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Psoriatic arthritis, TNFi and registries

Session Information

Date: Tuesday, November 12, 2019

Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster III: Psoriatic Arthritis, Clinical Features

Session Type: Poster Session (Tuesday)

Session Time: 9:00AM-11:00AM

Background/Purpose: The impact of gender on tumor necrosis factor inhibitors (TNFi) effectiveness has been poorly studied in Psoriatic Arthritis (PsA) patients. The objective of this work was to study gender differences in persistence and response to a first TNFi in PsA patients.

Methods: PsA patients prospectively followed at the Rheumatic Diseases Portuguese Registry (Reuma.pt), treated with a first TNFi, between 2001 and 2017 were included. Drug retention was assessed by Kaplan-Meier survival analysis and Cox models adjusted for the year of starting a TNFi. Response rates measured by European League Against Rheumatism (EULAR) response, Disease Activity Index for Psoriatic Arthritis (DAPSA) remission, Minimal Disease Activity (MDA) and Ankylosing Spondylitis Disease Activity Score (ASDAS) response, applying the LUNDEX method, were compared between genders. Baseline predictors of discontinuation and response were identified (Cox and multivariable multinomial/logistic regression models).

Results: 750 PsA patients were included, mean age 47.6(±11.6) years and 50.3% (n=377) females .PsA females showed significantly different baseline PsA disease characteristics in comparison with males: were older, more often obese, had a longer delay between diagnosis and the start of the first TNFi, had more severe peripheral disease activity and required more often concomitant corticosteroids and conventional synthetic disease modifying anti-rheumatic drug. The overall TNFi survival rates for females were also significantly lower when compared with those from males. Additionally, PsA females experienced lower rates of response as assessed by good EULAR response, DAPSA remission and MDA at 3 and 6 months, and by ASDAS at 6 months. Female gender was further identified as an independent predictor factor of worse persistence and showed a lower chance of good EULAR response.

Conclusion: PsA female patients from Reuma.pt have distinct PsA features and worse persistence and response to a first TNFi in comparison with males. More successful therapeutic approaches will require considering the impact of gender on TNFi effectiveness.

Disclosure: E. Vieira-Sousa, None; M. Eusébio, None; P. Ávila-Ribeiro, None; N. Khmelinskii, None; R. Cruz-Machado, None; T. Martins Rocha, None; M. Bernardes, Janssen-Cilag, 5, 8, Novartis, 5, AbbVie, 5, Amgen, 5, Pfizer, 5, Eli-Lilly, 5, Biogen, 5, Glaxo-Smith-Kline, 5; D. Santos-Faria, None; J. Leite Silva, None; H. Santos, AbbVie, 5, 8, Novartis, 5, 8, Pfizer, 5, 8, Janssen-Cilag, 5, 8, Eli-Lilly, 5; C. Miguel, None; P. Carvalho, None; T. Costa, None; L. Teixeira, None; T. Meirinhos, None; P. Nero, None; J. Eurico Fonseca, None; M. Santos, AbbVie, 8, Biogen, 8, Novartis, 8, Pfizer, 8, Roche, 8.

To cite this abstract in AMA style:

Vieira-Sousa E, Eusébio M, Ávila-Ribeiro P, Khmelinskii N, Cruz-Machado R, Martins Rocha T, Bernardes M, Santos-Faria D, Leite Silva J, Santos H, Miguel C, Carvalho P, Costa T, Teixeira L, Meirinhos T, Nero P, Eurico Fonseca J, Santos M. Gender Differences in Psoriatic Arthritis – Impact on Tumor Necrosis Factor Inhibitors Persistence and Response [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/gender-differences-in-psoriatic-arthritis-impact-on-tumor-necrosis-factor-inhibitors-persistence-and-response/. Accessed .

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