Sex differences in patient-reported outcomes and the association with clinical factors in axial spondyloarthritis patients treated with tumour necrosis factor inhibitors

Pasoon Hellamand; Marleen G H van de Sande; Michael T Nurmohamed; Ronald F van Vollenhoven; Rosemary J Hollick; Ovidiu Rotariu; Ziga Rotar; Katja P Pirkmajer; Dan Nordström; Anna-Mari Hokkanen; Brigitte Michelsen; Tore K Kvien; Bente Glintborg; Merete L Hetland; Mikkel Østergaard; Anne G Loft; Karel Pavelka; Jakub Zavada; Isabel Castrejon; Lucia Otero-Varela; Bjorn Gudbjornsson; Olafur Palsson; Tor Olofsson; Johan K Wallman; Adrian Ciurea; Michael J Nissen; Tuba D Yildirim; Fatos Onen; Catalin Codreanu; Corina Mogosan; Maria J Santos; Elsa Vieira-Sousa; Florenzo Iannone; Bruno Frediani; Lykke M Ørnbjerg; Jos W R Twisk; Irene E van der Horst-Bruinsma

doi:10.1093/rheumatology/keae370

Sex differences in patient-reported outcomes and the association with clinical factors in axial spondyloarthritis patients treated with tumour necrosis factor inhibitors

Pasoon Hellamand, Marleen G H van de Sande, Michael T Nurmohamed, Ronald F van Vollenhoven, Rosemary J Hollick, Ovidiu Rotariu, Ziga Rotar, Katja P Pirkmajer, Dan Nordström, Anna-Mari Hokkanen, Brigitte Michelsen, Tore K Kvien, Bente Glintborg, Merete L Hetland, Mikkel Østergaard, Anne G Loft, Karel Pavelka, Jakub Zavada, Isabel Castrejon, Lucia Otero-VarelaBjorn Gudbjornsson, Olafur Palsson, Tor Olofsson, Johan K Wallman, Adrian Ciurea, Michael J Nissen, Tuba D Yildirim, Fatos Onen, Catalin Codreanu, Corina Mogosan, Maria J Santos, Elsa Vieira-Sousa, Florenzo Iannone, Bruno Frediani, Lykke M Ørnbjerg, Jos W R Twisk, Irene E van der Horst-Bruinsma

Department for Rheumatology and Spine Diseases

Abstract

OBJECTIVES: To investigate sex differences in patient-reported outcome measures (PROMs) among axSpA patients initiating their first TNFi and identify factors contributing to these disparities over the follow-up.

METHODS: Data were included from 15 EuroSpA registries and consisted of axSpA patients initiating their first TNFi, with ≥2 measurements for each analysed PROM (BASDAI and BASFI, scale 0-100) taken at any time point. Linear mixed models were employed to analyse sex differences in PROMs over 24 months and to evaluate how baseline characteristics were related to the observed sex differences.

RESULTS: We analysed 13 102 (38% women) in the BASDAI analyses and 10 623 (38% women) in the BASFI analyses. At follow-up, mean sex differences in BASDAI increased from 4.3 units at baseline (95% CI, 3.5-5.1)-8.0 (7.2-8.8) at 6 months, and in BASFI from 2.2 (1.4-3.1)-4.6 (3.6-5.5), with consistently worse scores in women. Baseline characteristics could not substantially account for the observed sex differences over time; however, the magnitude of the sex differences was reduced by HLA-B27 positivity, longer disease duration, and increased CRP levels, but increased by TNFi initiation in later years and peripheral arthritis.

CONCLUSION: In axSpA patients initiating their first TNFi, baseline sex differences in BASDAI and BASFI increased two-fold after 6 months of treatment and persisted thereafter, with worse scores in women. Several baseline characteristics moderated the sex differences, though none could fully account for them. These findings improve our understanding of sex differences and underscore their importance in axSpA.

Original language	English
Journal	Rheumatology (Oxford, England)
ISSN	1462-0332
DOIs	https://doi.org/10.1093/rheumatology/keae370
Publication status	E-pub ahead of print - 23 Jul 2024

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Hellamand, P., van de Sande, M. G. H., Nurmohamed, M. T., van Vollenhoven, R. F., Hollick, R. J., Rotariu, O., Rotar, Z., Pirkmajer, K. P., Nordström, D., Hokkanen, A.-M., Michelsen, B., Kvien, T. K., Glintborg, B., Hetland, M. L., Østergaard, M., Loft, A. G., Pavelka, K., Zavada, J., Castrejon, I., ... van der Horst-Bruinsma, I. E. (2024). Sex differences in patient-reported outcomes and the association with clinical factors in axial spondyloarthritis patients treated with tumour necrosis factor inhibitors. Rheumatology (Oxford, England). Advance online publication. https://doi.org/10.1093/rheumatology/keae370

Sex differences in patient-reported outcomes and the association with clinical factors in axial spondyloarthritis patients treated with tumour necrosis factor inhibitors. / Hellamand, Pasoon; van de Sande, Marleen G H; Nurmohamed, Michael T et al.
In: Rheumatology (Oxford, England), 23.07.2024.

Research output: Contribution to journal › Journal article › Research › peer-review

Hellamand, P, van de Sande, MGH, Nurmohamed, MT, van Vollenhoven, RF, Hollick, RJ, Rotariu, O, Rotar, Z, Pirkmajer, KP, Nordström, D, Hokkanen, A-M, Michelsen, B, Kvien, TK, Glintborg, B , Hetland, ML , Østergaard, M, Loft, AG, Pavelka, K, Zavada, J, Castrejon, I, Otero-Varela, L, Gudbjornsson, B, Palsson, O, Olofsson, T, Wallman, JK, Ciurea, A, Nissen, MJ, Yildirim, TD, Onen, F, Codreanu, C, Mogosan, C, Santos, MJ, Vieira-Sousa, E, Iannone, F, Frediani, B, Ørnbjerg, LM, Twisk, JWR & van der Horst-Bruinsma, IE 2024, 'Sex differences in patient-reported outcomes and the association with clinical factors in axial spondyloarthritis patients treated with tumour necrosis factor inhibitors', Rheumatology (Oxford, England). https://doi.org/10.1093/rheumatology/keae370

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title = "Sex differences in patient-reported outcomes and the association with clinical factors in axial spondyloarthritis patients treated with tumour necrosis factor inhibitors",

abstract = "OBJECTIVES: To investigate sex differences in patient-reported outcome measures (PROMs) among axSpA patients initiating their first TNFi and identify factors contributing to these disparities over the follow-up.METHODS: Data were included from 15 EuroSpA registries and consisted of axSpA patients initiating their first TNFi, with ≥2 measurements for each analysed PROM (BASDAI and BASFI, scale 0-100) taken at any time point. Linear mixed models were employed to analyse sex differences in PROMs over 24 months and to evaluate how baseline characteristics were related to the observed sex differences.RESULTS: We analysed 13 102 (38% women) in the BASDAI analyses and 10 623 (38% women) in the BASFI analyses. At follow-up, mean sex differences in BASDAI increased from 4.3 units at baseline (95% CI, 3.5-5.1)-8.0 (7.2-8.8) at 6 months, and in BASFI from 2.2 (1.4-3.1)-4.6 (3.6-5.5), with consistently worse scores in women. Baseline characteristics could not substantially account for the observed sex differences over time; however, the magnitude of the sex differences was reduced by HLA-B27 positivity, longer disease duration, and increased CRP levels, but increased by TNFi initiation in later years and peripheral arthritis.CONCLUSION: In axSpA patients initiating their first TNFi, baseline sex differences in BASDAI and BASFI increased two-fold after 6 months of treatment and persisted thereafter, with worse scores in women. Several baseline characteristics moderated the sex differences, though none could fully account for them. These findings improve our understanding of sex differences and underscore their importance in axSpA.",

author = "Pasoon Hellamand and {van de Sande}, {Marleen G H} and Nurmohamed, {Michael T} and {van Vollenhoven}, {Ronald F} and Hollick, {Rosemary J} and Ovidiu Rotariu and Ziga Rotar and Pirkmajer, {Katja P} and Dan Nordstr{\"o}m and Anna-Mari Hokkanen and Brigitte Michelsen and Kvien, {Tore K} and Bente Glintborg and Hetland, {Merete L} and Mikkel {\O}stergaard and Loft, {Anne G} and Karel Pavelka and Jakub Zavada and Isabel Castrejon and Lucia Otero-Varela and Bjorn Gudbjornsson and Olafur Palsson and Tor Olofsson and Wallman, {Johan K} and Adrian Ciurea and Nissen, {Michael J} and Yildirim, {Tuba D} and Fatos Onen and Catalin Codreanu and Corina Mogosan and Santos, {Maria J} and Elsa Vieira-Sousa and Florenzo Iannone and Bruno Frediani and {\O}rnbjerg, {Lykke M} and Twisk, {Jos W R} and {van der Horst-Bruinsma}, {Irene E}",

note = "{\textcopyright} The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: [email protected].",

year = "2024",

month = jul,

day = "23",

doi = "10.1093/rheumatology/keae370",

language = "English",

journal = "Rheumatology (Oxford, England)",

issn = "1462-0332",

publisher = "Oxford University Press",

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TY - JOUR

T1 - Sex differences in patient-reported outcomes and the association with clinical factors in axial spondyloarthritis patients treated with tumour necrosis factor inhibitors

AU - Hellamand, Pasoon

AU - van de Sande, Marleen G H

AU - Nurmohamed, Michael T

AU - van Vollenhoven, Ronald F

AU - Hollick, Rosemary J

AU - Rotariu, Ovidiu

AU - Rotar, Ziga

AU - Pirkmajer, Katja P

AU - Nordström, Dan

AU - Hokkanen, Anna-Mari

AU - Michelsen, Brigitte

AU - Kvien, Tore K

AU - Glintborg, Bente

AU - Hetland, Merete L

AU - Østergaard, Mikkel

AU - Loft, Anne G

AU - Pavelka, Karel

AU - Zavada, Jakub

AU - Castrejon, Isabel

AU - Otero-Varela, Lucia

AU - Gudbjornsson, Bjorn

AU - Palsson, Olafur

AU - Olofsson, Tor

AU - Wallman, Johan K

AU - Ciurea, Adrian

AU - Nissen, Michael J

AU - Yildirim, Tuba D

AU - Onen, Fatos

AU - Codreanu, Catalin

AU - Mogosan, Corina

AU - Santos, Maria J

AU - Vieira-Sousa, Elsa

AU - Iannone, Florenzo

AU - Frediani, Bruno

AU - Ørnbjerg, Lykke M

AU - Twisk, Jos W R

AU - van der Horst-Bruinsma, Irene E

PY - 2024/7/23

Y1 - 2024/7/23

N2 - OBJECTIVES: To investigate sex differences in patient-reported outcome measures (PROMs) among axSpA patients initiating their first TNFi and identify factors contributing to these disparities over the follow-up.METHODS: Data were included from 15 EuroSpA registries and consisted of axSpA patients initiating their first TNFi, with ≥2 measurements for each analysed PROM (BASDAI and BASFI, scale 0-100) taken at any time point. Linear mixed models were employed to analyse sex differences in PROMs over 24 months and to evaluate how baseline characteristics were related to the observed sex differences.RESULTS: We analysed 13 102 (38% women) in the BASDAI analyses and 10 623 (38% women) in the BASFI analyses. At follow-up, mean sex differences in BASDAI increased from 4.3 units at baseline (95% CI, 3.5-5.1)-8.0 (7.2-8.8) at 6 months, and in BASFI from 2.2 (1.4-3.1)-4.6 (3.6-5.5), with consistently worse scores in women. Baseline characteristics could not substantially account for the observed sex differences over time; however, the magnitude of the sex differences was reduced by HLA-B27 positivity, longer disease duration, and increased CRP levels, but increased by TNFi initiation in later years and peripheral arthritis.CONCLUSION: In axSpA patients initiating their first TNFi, baseline sex differences in BASDAI and BASFI increased two-fold after 6 months of treatment and persisted thereafter, with worse scores in women. Several baseline characteristics moderated the sex differences, though none could fully account for them. These findings improve our understanding of sex differences and underscore their importance in axSpA.

AB - OBJECTIVES: To investigate sex differences in patient-reported outcome measures (PROMs) among axSpA patients initiating their first TNFi and identify factors contributing to these disparities over the follow-up.METHODS: Data were included from 15 EuroSpA registries and consisted of axSpA patients initiating their first TNFi, with ≥2 measurements for each analysed PROM (BASDAI and BASFI, scale 0-100) taken at any time point. Linear mixed models were employed to analyse sex differences in PROMs over 24 months and to evaluate how baseline characteristics were related to the observed sex differences.RESULTS: We analysed 13 102 (38% women) in the BASDAI analyses and 10 623 (38% women) in the BASFI analyses. At follow-up, mean sex differences in BASDAI increased from 4.3 units at baseline (95% CI, 3.5-5.1)-8.0 (7.2-8.8) at 6 months, and in BASFI from 2.2 (1.4-3.1)-4.6 (3.6-5.5), with consistently worse scores in women. Baseline characteristics could not substantially account for the observed sex differences over time; however, the magnitude of the sex differences was reduced by HLA-B27 positivity, longer disease duration, and increased CRP levels, but increased by TNFi initiation in later years and peripheral arthritis.CONCLUSION: In axSpA patients initiating their first TNFi, baseline sex differences in BASDAI and BASFI increased two-fold after 6 months of treatment and persisted thereafter, with worse scores in women. Several baseline characteristics moderated the sex differences, though none could fully account for them. These findings improve our understanding of sex differences and underscore their importance in axSpA.

U2 - 10.1093/rheumatology/keae370

DO - 10.1093/rheumatology/keae370

M3 - Journal article

C2 - 39041780

SN - 1462-0332

JO - Rheumatology (Oxford, England)

JF - Rheumatology (Oxford, England)

ER -

Sex differences in patient-reported outcomes and the association with clinical factors in axial spondyloarthritis patients treated with tumour necrosis factor inhibitors

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