Sex-specific outcomes in methotrexate therapy among patients with psoriatic arthritis and psoriasis

The purpose of this paper is to identify sex-specific patterns in methotrexate (MTX) therapy among patients with psoriatic arthritis (PsA) and psoriasis (PsO).

Data from adult patients treated with MTX monotherapy included in the Dutch southwest Early Psoriatic Arthritis Registry (rheumatology) or Continuous Assessment of Psoriasis Treatment Use REgistry with Methotrexate (dermatology) registries were obtained to create 2 cohorts of patients with PsA or PsO, respectively. Drug survival was assessed using Kaplan-Meier and Cox regression analyses. Disease activity, dosing, adverse events, and subsequent treatments were evaluated.

A total of 525 (50.1% female) patients were included in the PsA cohort and 217 (41.1% female) patients in the PsO cohort. In the PsA cohort, female sex was associated with shorter drug survival (adjusted hazard ratio [HR] = 2.5; 95% CI, 1.6-4.1; P < .001), whereas in the PsO cohort, female sex was associated with longer drug survival (HR = 0.6; 95% CI, 0.4-0.9; P = .008). Disease activity at MTX discontinuation was higher in females than males in the PsA cohort (Psoriatic Arthritis Disease Activity Score: 3.9 [1.0] vs 3.1 [1.5], P = 0.037), whereas in the PsO cohort, disease activity was higher in males than females (Psoriasis Area and Severity Index: 4.8 [6.4] vs 3.5 [3.7], P = .032). MTX dosing was comparable between sexes, though average doses were higher in the PsA than in the PsO cohort (18.2 [7.5] vs 15.0 [3.3] mg/wk, P < .001).

Drug survival and treatment response of MTX vary between PsA and PsO, with females in the PsA cohort while males in the PsO cohort having worse outcomes.