Response to tumor necrosis factor inhibition in male and female patients with ankylosing spondylitis: Data from a Swiss Cohort

Swiss Clinical Quality Management Program

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

OBJECTIVE: To investigate sex differences in connection with the effectiveness of tumor necrosis factor inhibitors (TNFi) in patients with ankylosing spondylitis (AS).

METHODS: A total of 440 patients with AS (294 men; 146 women) initiating a first TNFi in the prospective Swiss Clinical Quality Management Cohort were included. We evaluated the proportion of patients achieving the 20% and 40% improvement in the Assessment of Spondyloarthritis international Society criteria (ASAS20 and ASAS40) as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) improvement and status scores at 1 year. Patients having discontinued TNFi were considered nonresponders. Logistic regression analyses were performed to adjust for important predictors of response.

RESULTS: Compared to men, female patients had lower mean C-reactive protein levels, better spinal mobility, and more peripheral disease at the start. There was no sex disparity with regard to the ASDAS, the Bath Ankylosing Spondylitis Disease Activity and Functional indices, and the quality of life. At 1 year, 52% of women and 63% of men achieved an ASAS20 response (OR 0.63, 95% CI 0.37-1.07, p = 0.09). An inactive disease status (ASDAS < 1.3) was reached by 18% of women and 26% of men (OR 0.65, 95% CI 0.32-1.27, p = 0.22). These sex differences in response to TNFi were more pronounced in adjusted analyses (OR 0.34, 95% CI 0.16-0.71, p = 0.005 for ASAS20 and OR 0.10, 95% CI 0.03-0.31, p < 0.001 for ASDAS < 1.3) and confirmed for all the other outcomes assessed.

CONCLUSION: In AS, fewer women respond to TNFi and women show a reduced response in comparison to men.

Original languageEnglish
JournalJournal of Rheumatology
Volume45
Issue number4
Pages (from-to)506-512
ISSN0315-162X
DOIs
Publication statusPublished - Apr 2018

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Tumor Necrosis Factor-alpha
Sex Characteristics
Logistic Models
Regression Analysis
Quality of Life

Keywords

  • Ankylosing spondylitis
  • Tumor necrosis factor inhibition

Cite this

@article{553135249a164ae6acbbaf487292cb4c,
title = "Response to tumor necrosis factor inhibition in male and female patients with ankylosing spondylitis: Data from a Swiss Cohort",
abstract = "OBJECTIVE: To investigate sex differences in connection with the effectiveness of tumor necrosis factor inhibitors (TNFi) in patients with ankylosing spondylitis (AS).METHODS: A total of 440 patients with AS (294 men; 146 women) initiating a first TNFi in the prospective Swiss Clinical Quality Management Cohort were included. We evaluated the proportion of patients achieving the 20{\%} and 40{\%} improvement in the Assessment of Spondyloarthritis international Society criteria (ASAS20 and ASAS40) as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) improvement and status scores at 1 year. Patients having discontinued TNFi were considered nonresponders. Logistic regression analyses were performed to adjust for important predictors of response.RESULTS: Compared to men, female patients had lower mean C-reactive protein levels, better spinal mobility, and more peripheral disease at the start. There was no sex disparity with regard to the ASDAS, the Bath Ankylosing Spondylitis Disease Activity and Functional indices, and the quality of life. At 1 year, 52{\%} of women and 63{\%} of men achieved an ASAS20 response (OR 0.63, 95{\%} CI 0.37-1.07, p = 0.09). An inactive disease status (ASDAS < 1.3) was reached by 18{\%} of women and 26{\%} of men (OR 0.65, 95{\%} CI 0.32-1.27, p = 0.22). These sex differences in response to TNFi were more pronounced in adjusted analyses (OR 0.34, 95{\%} CI 0.16-0.71, p = 0.005 for ASAS20 and OR 0.10, 95{\%} CI 0.03-0.31, p < 0.001 for ASDAS < 1.3) and confirmed for all the other outcomes assessed.CONCLUSION: In AS, fewer women respond to TNFi and women show a reduced response in comparison to men.",
keywords = "Ankylosing spondylitis, Tumor necrosis factor inhibition",
author = "Monika Hebeisen and Regula Neuenschwander and Almut Scherer and Pascale Exer and Ulrich Weber and Giorgio Tamborrini and Raphael Micheroli and Wildi, {Lukas M.} and Pascal Zufferey and Nissen, {Michael J.} and Villiger, {Peter M.} and J{\"u}rg Bernhard and Axel Finckh and {Van Der Horst-Bruinsma}, {Irene E.} and Joachim Sieper and Robert Landew{\'e} and {Van Der Heijde}, D{\'e}sir{\'e}e and Adrian Ciurea and {Swiss Clinical Quality Management Program}",
year = "2018",
month = "4",
doi = "10.3899/jrheum.170166",
language = "English",
volume = "45",
pages = "506--512",
journal = "Journal of Rheumatology",
issn = "0315-162X",
publisher = "Journal of Rheumatology Publishing Co. Ltd.",
number = "4",

}

Response to tumor necrosis factor inhibition in male and female patients with ankylosing spondylitis : Data from a Swiss Cohort. / Swiss Clinical Quality Management Program.

In: Journal of Rheumatology, Vol. 45, No. 4, 04.2018, p. 506-512.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Response to tumor necrosis factor inhibition in male and female patients with ankylosing spondylitis

T2 - Data from a Swiss Cohort

AU - Hebeisen, Monika

AU - Neuenschwander, Regula

AU - Scherer, Almut

AU - Exer, Pascale

AU - Weber, Ulrich

AU - Tamborrini, Giorgio

AU - Micheroli, Raphael

AU - Wildi, Lukas M.

AU - Zufferey, Pascal

AU - Nissen, Michael J.

AU - Villiger, Peter M.

AU - Bernhard, Jürg

AU - Finckh, Axel

AU - Van Der Horst-Bruinsma, Irene E.

AU - Sieper, Joachim

AU - Landewé, Robert

AU - Van Der Heijde, Désirée

AU - Ciurea, Adrian

AU - Swiss Clinical Quality Management Program

PY - 2018/4

Y1 - 2018/4

N2 - OBJECTIVE: To investigate sex differences in connection with the effectiveness of tumor necrosis factor inhibitors (TNFi) in patients with ankylosing spondylitis (AS).METHODS: A total of 440 patients with AS (294 men; 146 women) initiating a first TNFi in the prospective Swiss Clinical Quality Management Cohort were included. We evaluated the proportion of patients achieving the 20% and 40% improvement in the Assessment of Spondyloarthritis international Society criteria (ASAS20 and ASAS40) as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) improvement and status scores at 1 year. Patients having discontinued TNFi were considered nonresponders. Logistic regression analyses were performed to adjust for important predictors of response.RESULTS: Compared to men, female patients had lower mean C-reactive protein levels, better spinal mobility, and more peripheral disease at the start. There was no sex disparity with regard to the ASDAS, the Bath Ankylosing Spondylitis Disease Activity and Functional indices, and the quality of life. At 1 year, 52% of women and 63% of men achieved an ASAS20 response (OR 0.63, 95% CI 0.37-1.07, p = 0.09). An inactive disease status (ASDAS < 1.3) was reached by 18% of women and 26% of men (OR 0.65, 95% CI 0.32-1.27, p = 0.22). These sex differences in response to TNFi were more pronounced in adjusted analyses (OR 0.34, 95% CI 0.16-0.71, p = 0.005 for ASAS20 and OR 0.10, 95% CI 0.03-0.31, p < 0.001 for ASDAS < 1.3) and confirmed for all the other outcomes assessed.CONCLUSION: In AS, fewer women respond to TNFi and women show a reduced response in comparison to men.

AB - OBJECTIVE: To investigate sex differences in connection with the effectiveness of tumor necrosis factor inhibitors (TNFi) in patients with ankylosing spondylitis (AS).METHODS: A total of 440 patients with AS (294 men; 146 women) initiating a first TNFi in the prospective Swiss Clinical Quality Management Cohort were included. We evaluated the proportion of patients achieving the 20% and 40% improvement in the Assessment of Spondyloarthritis international Society criteria (ASAS20 and ASAS40) as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) improvement and status scores at 1 year. Patients having discontinued TNFi were considered nonresponders. Logistic regression analyses were performed to adjust for important predictors of response.RESULTS: Compared to men, female patients had lower mean C-reactive protein levels, better spinal mobility, and more peripheral disease at the start. There was no sex disparity with regard to the ASDAS, the Bath Ankylosing Spondylitis Disease Activity and Functional indices, and the quality of life. At 1 year, 52% of women and 63% of men achieved an ASAS20 response (OR 0.63, 95% CI 0.37-1.07, p = 0.09). An inactive disease status (ASDAS < 1.3) was reached by 18% of women and 26% of men (OR 0.65, 95% CI 0.32-1.27, p = 0.22). These sex differences in response to TNFi were more pronounced in adjusted analyses (OR 0.34, 95% CI 0.16-0.71, p = 0.005 for ASAS20 and OR 0.10, 95% CI 0.03-0.31, p < 0.001 for ASDAS < 1.3) and confirmed for all the other outcomes assessed.CONCLUSION: In AS, fewer women respond to TNFi and women show a reduced response in comparison to men.

KW - Ankylosing spondylitis

KW - Tumor necrosis factor inhibition

U2 - 10.3899/jrheum.170166

DO - 10.3899/jrheum.170166

M3 - Journal article

C2 - 29449504

AN - SCOPUS:85044718498

VL - 45

SP - 506

EP - 512

JO - Journal of Rheumatology

JF - Journal of Rheumatology

SN - 0315-162X

IS - 4

ER -