(114) Are Women with Rheumatoid Arthritis Really Less Likely to Achieve Remission with Biologics? A Cohort Study in The Swiss Clinical Quality Management Cohort

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 445

Presenting Author(s)

Enriqueta Vallejo-Yague
– PhD Candidate, Swiss Federal Institute of Technology, Z�rich, Z�rich, Switzerland

Co-Author(s)

Julia N. Pfund
– Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Zurich, Switzerland
Theresa Burkard, PhD
– Postdoctoral researcher, ETH Zurich, Zurich, Switzerland
Carole Clair
– Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
Raphael Micheroli
– Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
Burkhard Möller
– Rheumatology, Immunology and Allergy, Inselspital, University Hospital of Bern, Bern, Switzerland
Axel Finckh
– Division of Rheumatology, University Hospitals of Geneva, Geneva, Switzerland
Andrea Burden
– Professor, Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Zurich, Switzerland

Background: Rheumatoid arthritis (RA) affects women three times more frequently than men. Additionally, compared to men, women may have a lower likelihood of achieving clinical response, but data related to this topic are controversial.

Objectives: We aimed to compare the likelihood of achieving remission across men and women with RA, who started their first biologic or targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARD).

Methods: This observational cohort study in the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) registry included adult RA patients who started their first b/tsDMARD (from 1997 to 31/April/2018). Patient characteristics at start of the b/tsDMARD were compared between men and women. Logistic regression was used to assess the likelihood of achieving remission during the first year after b/tsDMARD start, defined by disease activity score 28 (DAS28) < 2.6, in men compared to women (reference group). Secondary analyses were adjusted for age and seropositivity as prognostic factors. Subsequently, we conducted mediation analyses to investigate the role of potential mediators or factors that could explain the findings from the main analysis.

Results: The study included 3722 RA patients, of which 2839 (76.3%) were women and 883 (23.7%) were men. Compared to women, men were older at diagnosis and start of b/tsDMARDs, and had shorter time from diagnosis to their first b/tsDMARD (3.4 vs 5.0 years, p< 0.001). At baseline (b/tsDMARD initiation), women had significantly higher disease activity (DAS28) and worse patient-reported outcomes (Health Assessment Questionnaire, tender joints). Concomitant osteoporosis and depression/anxiety were more frequent among women, while men had more frequent diabetes and prior or current smoking record. Physician’s global disease assessment and swollen joints were similar across groups. Compared to women, men had 21% increased odds of achieving DAS28-remission, with an odds ratio (OR) 1.21, 95% confidence interval (CI) 1.02-1.42. Secondary analyses adjusting by for age and seropositivity did not change the findings (adjusted OR 1.24, 95% CI 1.05-1.46). Our analyses of potential mediators suggested that the observed effect may be explained by the shorter disease duration and lower DAS28 at treatment initiation in men vs women.

Conclusions: Men started b/tsDMARD earlier than women, particularly regarding disease duration and disease activity (DAS28) at b/tsDMARD initiation, and they presented higher odds of remission. This highlights the importance of an earlier treatment, and it suggests to target an earlier stage of disease in women to match the benefits observed in men.