No Sex Bias in the Escalation of Therapy in the Treatment of Early Inflammatory Arthritis

Stephanie Garner¹, Cheryl Barnabe², Gilles Boire³, Carol Hitchon⁴, Edward C. Keystone⁵, Boulos Haraoui⁶, J Carter Thorne⁷, Diane Tin⁸, Janet E. Pope⁹, VP Bykerk¹⁰ and CATCH Investigators, ¹University of Calgary, Calgary, AB, Canada, ²Cumming School of Medicine, University of Calgary, Calgary, AB, Canada, ³Department of Medicine/Division of Rheumatology, Université de Sherbrooke, Sherbrooke, QC, Canada, ⁴Department of Rheumatology, University of Manitoba, Winnipeg, MB, Canada, ⁵Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, ⁶Institut de Rhumatologie, Montreal, QC, Canada, ⁷University of Toronto, Toronto, ON, Canada, ⁸The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, ⁹University of Western Ontario, London, ON, Canada, ¹⁰Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Early Rheumatoid Arthritis, sex bias and treatment

Session Information

Date: Sunday, November 8, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster I

Session Type: ACR Poster Session A

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

Background/Purpose:
Several studies have shown that females with early
inflammatory arthritis have higher disease activity, worse functional
impairment and worse patient-reported outcomes but do not acquire more
radiographic damage. It is hypothesized that the current measurement tools for
disease activity are biased against females. The Hospital Universitario
La Princesa Index (HUPI) is a validated tool in early
RA and has been proposed to correct sex bias by adjusting for both the tender
joint count (TJC 28) and ESR for males and females. The purpose of this study
was to assess for sex differences in disease activity states between males and
females as measured by the DAS28 and the HUPI, and whether there are
differences in escalation of therapy between the sexes.

Methods:
Data from the Canadian Early Arthritis Cohort
(CATCH) were used for a sex-stratified analysis of disease activity and treatment
escalation at 3, 6, 12, 24 and 60- month follow-up. Patients were included if
they met the ACR 1987 or 2010 classification criteria for RA and their sex was
documented. For the analysis, patients were classified into remission, low
disease activity and moderate/high disease activity using the DAS28 and the
HUPI cutpoints. Treatment escalation was defined as
any of: 1) increased dose of methotrexate; 2) addition of a new DMARD; 3) addition
of a biologic agent; or 4) switching a biologic agent.

Results:
2228 patients (1619 females, 609 males) met the
inclusion criteria. Females were younger (52 vs 58
years, p<0.001) and more frequently seropositive (72% vs
64%, p<0.001). Males had more erosions at baseline (14% vs 9%, p<0.004)
and higher swollen joint count (9 vs 7, p<0.001).
The DAS28 was similar in both groups at baseline (5.1 vs
5.0, p=0.6) but HUPI score were higher in males (8.9 vs
8.3, p<0.0001). More females were taking NSAIDs (60% vs
52%, p<0.001) and steroids (81% vs 59%,
p<0.002) at inception to the cohort but these differences resolved by twelve
months. The proportion of patients on DMARDs and biologic agents did not differ
by sex at any time point. There were no sex differences in the escalation of
therapy when patients were stratified by DAS28 or HUPI disease activity level
(Table 1). More males were in DAS28 remission at 60 months (67% vs 52%,p=0.01) but the same
proportion were in HUPI remission (53% vs 50%). There
were no sex differences in the proportion of patients with erosions at 24 and
60 months.

Conclusion:
There were no sex differences in treatment or
escalation of therapy by disease activity state. Increased effort to treat to
target for all patients is warranted.

Table 1. Escalation of Therapy in DAS28 or HUPI Moderate or High Disease Activity States, Stratified by Sex
	DAS28 Moderate/High		HUPI Moderate/High
	Male	Female	Male	Female
Month 3	45%	46%	45%	50%
Month 6	33%	36%	33%	39%
Month 12	20%	26%	20%	27%
Month 24	33%	26%	34%	31%
Month 60	27%	14%	27%	15%

Disclosure: S. Garner, None; C. Barnabe, None; G. Boire, None; C. Hitchon, Health Sciences Centre Foundation, 2; E. C. Keystone, Janssen Inc., 2,Abbott/AbbVie, 5,Amgen, 2,Bristol-Myers Squibb, 5,Janssen Inc., 5,Hoffmann-La Roche, Inc., 5,Janssen Inc., 2,Janssen Inc., 5,Merck Pharmaceuticals, 5,Merck Pharmaceuticals, 5,Pfizer Pharmaceuticals, 5,Pfizer Pharmaceuticals, 5; B. Haraoui, Abbott, Amgen, BMS, Janssen, Pfizer, Roche and UCB Pharma, 2,Abbott, Amgen, BMS, Janssen, Pfizer, Roche and UCB Pharma, 5,Abbott, Amgen, BMS, Janssen, Pfizer, Roche and UCB Pharma, 8; J. C. Thorne, Amgen, Canada, 5; D. Tin, None; J. E. Pope, None; V. Bykerk, None.

To cite this abstract in AMA style:

Garner S, Barnabe C, Boire G, Hitchon C, Keystone EC, Haraoui B, Thorne JC, Tin D, Pope JE, Bykerk V. No Sex Bias in the Escalation of Therapy in the Treatment of Early Inflammatory Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/no-sex-bias-in-the-escalation-of-therapy-in-the-treatment-of-early-inflammatory-arthritis/. Accessed .

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