Neuenschwander Regula, Hebeisen Monika, Micheroli Raphael, Bürki Kristina, Exer Pascale, Niedermann Karin, Nissen Michael J, Scherer Almut, Ciurea Adrian
Department of Rheumatology, Zurich University Hospital, Gloriastrasse 25, CH-8091, Zurich, Switzerland.
Swiss Clinical Quality Management Foundation, Statistics Group, Zurich, Switzerland.
Arthritis Res Ther. 2020 Oct 9;22(1):233. doi: 10.1186/s13075-020-02337-2.
Sex differences with regard to clinical manifestations and response to tumor necrosis factor inhibitors (TNFi) have been delineated for the radiographic form of axial spondyloarthritis (axSpA). More limited evidence for a differential effectiveness of treatment in genders exists for the nonradiographic disease state (nr-axSpA). The aim of the study was to compare demographics, clinical parameters, and response to TNFi in women versus men with nr-axSpA.
We compared disease characteristics of 264 women and 231 men with nr-axSpA at inclusion in the prospective Swiss Clinical Quality Management Cohort. Response to a first TNFi was assessed in 85 women and 78 men without diagnosed co-morbid fibromyalgia. The primary outcome was the proportion of patients achieving the 40% improvement in the Assessment of SpondyloArthritis international Society criteria (ASAS40) at 1 year. Additional response outcomes were evaluated as secondary outcomes. Patients having discontinued TNFi were considered non-responders. Logistic regression analyses were adjusted for baseline differences, which might potentially mediate the effect of sex on treatment response.
Compared to men, women had a longer diagnostic delay, a higher level of perceived disease activity, and more enthesitis and were in a lower percentage HLA-B27 positive. An ASAS40 response was achieved by 17% of women and 38% of men (OR 0.34; 95% CI 0.12, 0.93; p = 0.02). A significantly lower response rate in women was confirmed in the adjusted analysis (OR 0.19; 95% CI 0.05, 0.62; p = 0.009) as well as for the other outcomes assessed.
Despite only few sex differences in patient characteristics in nr-axSpA, response rates to TNFi are significantly lower in women than in men.
对于轴性脊柱关节炎（axSpA）的放射学类型，已明确其在临床表现及对肿瘤坏死因子抑制剂（TNFi）反应方面的性别差异。对于非放射学疾病状态（nr-axSpA），关于治疗在性别上存在不同疗效的证据更为有限。本研究的目的是比较nr-axSpA女性和男性的人口统计学特征、临床参数以及对TNFi的反应。
我们比较了前瞻性瑞士临床质量管理队列中纳入的264例nr-axSpA女性和231例nr-axSpA男性的疾病特征。在85例未诊断合并纤维肌痛的女性和78例未诊断合并纤维肌痛的男性中评估了对首次TNFi的反应。主要结局是在1年时达到国际脊柱关节炎评估协会标准（ASAS40）改善40%的患者比例。其他反应结局作为次要结局进行评估。停用TNFi的患者被视为无反应者。逻辑回归分析针对可能介导性别对治疗反应影响的基线差异进行了调整。
与男性相比，女性的诊断延迟更长，疾病活动感知水平更高，附着点炎更多，且HLA-B27阳性率更低。17%的女性和38%的男性达到了ASAS40反应（比值比0.34；95%置信区间0.12，0.93；p = 0.02）。在调整分析中以及对评估的其他结局中，均证实女性的反应率显著更低（比值比0.19；95%置信区间0.05，0.62；p = 0.009）。
尽管nr-axSpA患者特征方面只有少数性别差异，但女性对TNFi的反应率显著低于男性。
