Sex Differences in Response and Persistence to Biologic Therapy in Psoriatic Arthritis: A 52-Week Analysis With Extended Long-Term Outcomes.

Psoriatic arthritis (PsA) is a chronic immune-mediated disease with heterogeneous joint and skin manifestations. Although biologic therapies targeting TNFα, IL-17, and IL-23 have transformed PsA management, sex-specific differences in efficacy and treatment persistence remain underexplored. Previous registry and real-world data suggest that women may experience greater pain, lower treatment response, and shorter drug survival, but evidence integrating both articular and cutaneous outcomes is limited. This retrospective cohort study investigated whether female sex independently predicts reduced clinical response and persistence with biologic therapy in PsA, focusing on composite outcomes at week 52. A total of 134 patients (87 men, 47 women) who initiated biologics between 2011 and 2024 were analyzed. Diagnoses were confirmed according to CASPAR by board-certified dermatologists, with rheumatologic confirmation when required. Propensity scores derived from baseline age, BMI, duration of psoriasis, duration of PsA, baseline Psoriasis Area and Severity Index (PASI), baseline Disease Activity index for Psoriatic Arthritis (DAPSA), comorbidities, NSAID use, and biologic class were incorporated into covariate-adjusted ANCOVA models. At week 52, simultaneous achievement of PASI90 and DAPSA remission was observed in 51.2% of men versus 19.2% of women (p = 0.025). Female sex remained an independent negative predictor of response (adjusted OR = 0.19; 95% CI: 0.074-0.468; p = 0.0001). Kaplan-Meier analysis demonstrated shorter treatment persistence in women (log-rank p = 0.0099; adjusted HR = 0.316, 95% CI: 0.119-0.841). Although only a few women (n = 3) cited financial burden as a reason for not re-initiating biologics after discontinuation, this observation may still reflect underlying socioeconomic influences. Even small numbers of such cases can exemplify practical and economic barriers-often compounded by caregiving responsibilities or lower household income-that disproportionately affect women. Early and proactive intervention, prevention of unnecessary discontinuation, and timely re-initiation upon relapse are essential to optimize outcomes in women with PsA.