Sex Differences in Response and Persistence to Biologic Therapy in Psoriatic Arthritis: A 52-Week Analysis With...

Area of Science:

• Rheumatology and Immunology
• Dermatology
• Pharmacology

Background:

• Psoriatic arthritis (PsA) is a chronic immune-mediated condition with varied joint and skin symptoms.
• Biologic therapies targeting TNFα, IL-17, and IL-23 have improved PsA management.
• Sex-specific differences in biologic therapy efficacy and persistence in PsA are not well understood, particularly regarding combined articular and cutaneous outcomes.

Purpose of the Study:

• To investigate if female sex independently predicts reduced clinical response and treatment persistence with biologic therapy in PsA patients.
• To analyze composite outcomes at week 52, integrating both skin (PASI90) and joint (DAPSA remission) measures.
• To identify potential factors influencing treatment outcomes in women with PsA.

Main Methods:

• Retrospective cohort study of 134 PsA patients (47 women, 87 men) initiating biologics.
• Propensity score adjustment for baseline characteristics including age, BMI, disease duration, PASI, DAPSA, comorbidities, NSAID use, and biologic class.
• Analysis of simultaneous PASI90 and DAPSA remission at week 52 and treatment persistence using Kaplan-Meier analysis.

Main Results:

• At week 52, 19.2% of women achieved simultaneous PASI90 and DAPSA remission compared to 51.2% of men (p=0.025).
• Female sex was an independent negative predictor of response (adjusted OR=0.19; p=0.0001).
• Women demonstrated significantly shorter treatment persistence (log-rank p=0.0099; adjusted HR=0.316).

Conclusions:

• Female sex is independently associated with poorer clinical response and reduced treatment persistence in psoriatic arthritis patients on biologic therapy.
• Socioeconomic factors, such as financial burden and caregiving responsibilities, may disproportionately impact treatment adherence and persistence in women.
• Proactive interventions, prevention of unnecessary discontinuation, and timely re-initiation are crucial for optimizing outcomes in women with PsA.