Initial RA treatments for men more aggressive than for women
Physicians generally prescribe different initial treatments for men and women with rheumatoid arthritis, suggesting a slightly less aggressive approach for women compared with men, according to findings published in the Journal of Rheumatology.
“In the past, when treatment possibilities were limited, and a higher disease activity was common, RA resulted in unfavorable outcomes in both male and female patients,” Sytske Ann Bergstra, MSc, of the Leiden University Medical Center, told Healio Rheumatology. “However, nowadays several publications have suggested that men are more likely to achieve a favorable treatment response. If this is true, this would mean that men and women may have different treatment needs in clinical practice.”
To investigate whether rheumatologists make different treatment choices for male and female patients with RA, and whether men and women respond differently to their prescribed treatment, Bergstra and colleagues analyzed data from the Measurements of Efficacy of Treatment in the Era of Outcome in Rheumatology (METEOR) registry, an international, observational database of daily clinical practice records. Among the total 36,576 patients included in the METEOR register, 5,820 fulfilled the researchers’ inclusion criteria. Of those, 1,142 men and 4,393 women had the appropriate data available and were included in the analysis.
The researchers analyzed all visits from the start of the first disease modifying antirheumatic drug until the first DMARD switch, or the end of follow-up. In addition, they used Cox regression to determine the effect of sex on time-to-switch from the first to second treatment. Lastly, they used linear mixed model analyses to find whether men and women responded to treatment differently, as measured by the DAS the Health Assessment Questionnaire.
According to the researchers, physicians more often prescribed hydroxychloroquine, as monotherapy or in combination with methotrexate or a glucocorticoid, as an initial treatment for women with RA. Men with RA more often initially received methotrexate or sulfasalazine, or sometime both in combination. Women experienced a shorter time-to-switch DMARD, and had a DAS that was statistically significantly higher ( = –0.58; 95% CI, –0.62 to –0.55) over time than men ( = –0.69; 95% CI, –0.75 to –0.62). In addition, the researchers found no differences in the response to treatment between men and women.
“This suggests a slightly less aggressive approach in women compared to men,” Bergstra told Healio Rheumatology. “Hydroxychloroquine was prescribed to male patients mostly if they had low disease activity, but in women the prescription of hydroxychloroquine seemed to be irrespective of disease activity. We did find a slightly worse response to treatment for women than for men, but the difference was small and clinically negligible. These results are relevant for clinical practice, as it seems that women are in some cases treated less aggressively than men, whereas the clinical response is similar for both sexes.” – by Jason Laday
Disclosure: Bergstra reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.