Sex Differences in Treatment Response to Targeted Therapy in Rheumatoid Arthritis: A Post Hoc Analysis of a Prospective Observational Study.

BACKGROUND

Sex differences in treatment outcomes for rheumatoid arthritis (RA) have been inconsistently reported. This study aimed to investigate whether male and female patients with RA have different treatment responses to their first-line targeted therapies.

METHODS

This post hoc analysis used data from a prospective multicenter observational study of patients with RA initiating biologic disease-modifying anti-rheumatic drugs or Janus kinase inhibitors for the first time. The primary outcome was remission measured by the 28-joint Disease Activity Score with erythrocyte sedimentation rate (DAS28-ESR) at week 24. Remission rates were compared between male and female patients. Conditional logistic regression models, matched on RA disease duration and baseline disease activity, were used to analyze the independent effect of sex on remission.

RESULTS

Overall, 78 male and 428 female patients were included. In the per-protocol analysis, the DAS28-ESR remission rates at week 24 were higher in male patients (44.3%) than in female patients (28.9%) (P = 0.025). Conditional logistic regression showed that male sex was independently associated with achieving remission (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 1.25-6.08). In the subgroup of patients with early RA (disease duration ≤ 2 years), male patients had significantly higher odds of achieving remission than female patients (aOR, 11.59; 95% CI, 2.56-52.54). A similar trend was observed in the subgroup of patients who initiated Janus kinase inhibitors (aOR, 2.37; 95% CI, 1.02-5.52).

CONCLUSION

Male patients with RA achieve higher remission rates than female patients when initiating first-line targeted therapies, particularly in early disease. These findings suggest the need for sex-specific strategies in RA management.