The Clinical Response to Biologic and Non-Biologic Disease Modifying Antirheumatic Drugs (DMARDs) According to Gender in a French-Canadian Population with Rheumatoid Arthritis (RA)

Sonia Lagacé¹, Louis Bessette^2,3, Louis Coupal⁴ and Denis Choquette⁴, ¹Medicine, Laval University, Quebec, QC, Canada, ²Rheumatology, Laval University, Québec, QC, Canada, ³Rhumatologie, CHU de Québec - Université Laval, Quebec, QC, Canada, ⁴Rheumatology, Institut de Recherche en Rhumatologie de Montréal (IRRM), Montréal, QC, Canada

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Biologics, Clinical Response, DMARDs, rheumatoid arthritis (RA) and treatment

Session Information

Date: Sunday, November 13, 2016

Title: Rheumatoid Arthritis – Small Molecules, Biologics and Gene Therapy - Poster I

Session Type: ACR Poster Session A

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

Background/Purpose: Several studies have reported that women with RA had higher level of pain, disease activity and functional impairment compared to men. In addition, women also seem to response less than men to biologic DMARDs (bDMARDs) and non-biologic DMARDs (nbDMARDs). Outcomes: Describe the disease activity and the clinical response to methotrexate (MTX) and bDMARDs in men and women with RA and evaluate the factors that could influence difference observed between genders.

Methods: Data on RA patients starting a treatment with MTX or a first bDMARD were extracted for the Rhumadata clinical database used in two rheumatologic centers. The baseline characteristics, the duration of the disease before the initiation of treatment, the concomitant treatments, the inflammatory markers (sedimentation rate, C-reactive protein) and the immunologic factor (rheumatoid factor, Anti-CCP) were extracted according to gender. A univariate analysis comparing the mean change between the men and women in the methotrexate and in the biologic groups was conducted for the « Health Assessment Questionnaire (HAQ)» and the « Clinical Disease Activity Index (CDAI) » at 6 and 12 months. A mutivariate analysis comparing those same parameters to adjust for the different baseline’s characteristics is being conducted.

Results: 922 women (mean age: 53 (± 13); mean disease duration: 1.3 years (± 5.3)) and 316 men (mean age: 57 (± 12); mean disease duration: 1.5 years (± 5.4)) started MTX. 548 women (mean age: 54 (± 13); mean disease duration: 7.6 years (± 7.7)) and 159 men (mean age: 56 (± 12); mean disease duration: 6.6 years (± 7.4)) started a first bDMARD (TNFi: 84%). In the univariate analysis, the mean HAQ score at baseline, 6 and 12 months were higher in women than in men in the MTX group. However, both groups had a similar means change in HAQ score at 6 and 12 months. For the CDAI score, women and men in both groups had similar score at baseline, 6 and 12 months. Mean change in the CDAI score at 6 and 12 months was a slightly higher in men than women in both treatment groups, but the change was not statistically significant.

Conclusion: In this cohort of RA patients, women seem to have a more severe functional impairment throughout their illness, but do not seem to have a poorer response to nbDMARDs and bDMARDs compared to men. The analysis evaluating factors influencing disease activity changes over time in men and women is ongoing. Table

	Methotrexate			First Biologic Agent
	Male	Female	P value	Male	Female	P value
N	316	922		159	548
Mean HAQ Score
Baseline	0.68 (0.54)	1.04 (0.66)	0,0005	1.12 (0.67)	1.33 (0.63)	0,0030
6 months	0.26 (0.38)	0.64 (0.66)	0,0001	0.56 (0.63)	0.86 (0.72)	0,0035
12 months	0.30 (0.44)	0.68 (0.62)	0,0024	0.55 (0.59)	0.84 (0.69)	0,0001
Mean change in HAQ Score
6 months	-0.43 (0.50)	-0.37 (0.55)	0,5250	-0.48 (0.60)	-0.41 (0.59)	0,4590
12 months	-0.42 (0.49)	-0.40 (0.63)	0,8451	-0.56 (0.69)	-0.42 (0.56)	0,1683
Mean CDAI Score
Baseline	19.95 (15.50)	20.64 (13.25)	0,8077	27.68 (14.12)	24.77 (12.03)	0,1210
6 months	5.20 (4.05)	8.09 (6.56)	0,0429	10.29 (10.42)	7.39 (6.14)	0,1689
12 months	4.80 (8.20)	6.40 (6.79)	0,4788	4.85 (4.66)	6.38 (5.88)	0,2336
Mean Change in CDAI Score
6 months	-11.94 (15.00)	-11.40 (13.65)	0,8918	-21.10 (11.31)	-18.03 (11.91)	0,2273
12 months	-16.31 (18.37)	-12.11 (13.83)	0,3784	-25.64 (12.79)	-21.46 (11.50)	0,1257

Disclosure: S. Lagacé, None; L. Bessette, AbbVie, 2,Amgen, 2,BMS, 2,Pfizer Inc, 2,Roche Pharmaceuticals, 2,UCB, 2,AbbVie, 5,Amgen, 5,BMS, 5,Pfizer Inc, 5,Roche Pharmaceuticals, 5,UCB, 5,AbbVie, 8,Amgen, 8,BMS, 8,Pfizer Inc, 8,Roche Pharmaceuticals, 8,UCB, 8; L. Coupal, None; D. Choquette, None.

To cite this abstract in AMA style:

Lagacé S, Bessette L, Coupal L, Choquette D. The Clinical Response to Biologic and Non-Biologic Disease Modifying Antirheumatic Drugs (DMARDs) According to Gender in a French-Canadian Population with Rheumatoid Arthritis (RA) [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/the-clinical-response-to-biologic-and-non-biologic-disease-modifying-antirheumatic-drugs-dmards-according-to-gender-in-a-french-canadian-population-with-rheumatoid-arthritis-ra/. Accessed .

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