Musculoskeletal and dermatological manifestations such as axial inflammation, arthritis, and psoriasis of the skin and nails poses a significant burden on patients with psoriatic arthritis (PsA). According to research published in Rheumatology, female patients with PsA are more likely than male patients to have severe disease and less likely to experience low or no disease activity. The results of this study also reported that females were less persistent in receiving biologic disease-modifying anti-rheumatic drugs than males (P < 0.001).
Dr. Arno W. R. Van Juijk and co-investigators conducted the PsABio study to assess sex-based differences in disease outcomes and treatment impact among PsA patients. This prospective, real-world, observational cohort study evaluated ustekinumab or a tumor necrosis factor inhibitor (TNFi) as first-, second-, or third-line therapy. The initial disease duration for 512 females and 417 males were 6.7 and 6.9 years, respectively. The clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) was 32.3 versus 26.8 for males and females, while the Health Assessment Questionnaire-Disability Index (HAQ-DI) was 1.3 versus 0.93 for males and females. Experts reported less significant scores in female patients than in males. At 12 months, cDAPSA low disease activity was achieved in 175/303 female and 212/264 male patients, while minimal disease activity was attained in 96/285 and 137/247 patients. The total Psoriatic Arthritis Impact of Disease-12 scores were 3.5 compared to 2.4, and HAQ-DI scores were 0.85 versus 0.50. According to the experts, regardless of gender or biologic disease-modifying anti-rheumatic drugs, ineffectiveness was the main cause for discontinuation.
Similarly, a 2021 study evaluated the real-world treatment persistence and impact of ustekinumab or TNFi in PsA patients after one-year follow-up. The PsABio study showed a similar persistence between the ustekinumab (317/438) and tumor necrosis factor inhibitor (321/455) groups. In terms of the clinical Disease Activity Index for Psoriatic Arthritis, the ustekinumab group had low disease activity/remission rates of 55.9%/22.1%, while the TNFi group had rates of 67.1%/31.7%. The rates of minimal disease activity/very low disease activity were 34.2%/11.9% for patients treated with ustekinumab and 43.1%/12.6% for those treated with TNFi.The propensity score-adjusted odds ratios were 0.89 and 0.90 for minimal disease activity and very low disease activity. Although unadjusted persistence and effectiveness for ustekinumab and TNFi were numerically slightly higher after a year of treatment, the propensity score-adjusted comparisons showed comparable overall persistence, effectiveness, and safety for both modes of action in PsA.
Although sex-based differences in disease outcomes and treatment impact have been observed, both treatments have demonstrated improvements in disease activity and symptoms in both male and female patients. These findings support the use of either ustekinumab or TNFi as viable treatment options for PsA patients and underline the importance of individualized treatment decisions based on patient characteristics and preferences.
- Van Kuijk AW, Nurmohamed MT, Siebert S, Bergmans P, de Vlam K, Gremese E, et al. Gender-specific differences in patients with psoriatic arthritis receiving ustekinumab or tumour necrosis factor inhibitor: real-world data. Rheumatology. 2023 Feb 22.
- Gossec L, Siebert S, Bergmans P, de Vlam K, Gremese E, Joven-Ibáñez B, et al. Persistence and effectiveness of the IL-12/23 pathway inhibitor ustekinumab or tumour necrosis factor inhibitor treatment in patients with psoriatic arthritis: 1-year results from the real-world PsABio Study. Annals of the Rheumatic Diseases. 2022 Jun 1;81(6):823-30.