Women with psoriatic arthritis (PsA) showed lower treatment persistence than men when treated with tumor necrosis factor inhibitors (TNFis) or interleukin-17 inhibitors (IL17i) but the difference between sexes for persistence is not significant when patients are treated with IL-12/23 or IL-23 inhibitors or with Janus kinase (JAK) inhibitors, Laura Pina Vegas, MD, PhD, told attendees at ACR Convergence.

“This may be due to differences in rheumatic phenotype, disease activity/severity or immunogenicity, but also to disparities in health care-seeking behavior due to gender norms,” she said.

Dr Pina Vegas is a rheumatologist at Henri Mondor University Hospital (APHP) in Créteil, France.

She explained that the objective of her research “was to assess the influence of sex on the long-term persistence of each class of targeted therapies in a national healthcare database.” “Persistence was defined as the time from treatment initiation to discontinuation and was estimated by the Kaplan-Meier method,” Dr Pina Vegas explained.

This cohort study drew from the administrative health care database of the French health insurance program. Participants included new users of targeted therapies during 2015-2021, for a total of 14,778 patients; 8,475 (57%) were women (mean age 50±13 years), and 6,303 (43%) were men (51±13 years).

Among women, 9462 (60%) used TNFis; 3762 (24%) were treated with IL17i; 1639 (10%) were on IL12/23i; 392 (2%) were treated with IL23i; and 576 (4%) used JAKis. Among men 6192 (59%) were treated with TNFi; 2433 (23%) used IL17i; 1170 (11%) were on IL12/23i ;406 (4%) used IL23i; and nd 287 (3%) were treated with JAKis.

“Overall, 1-year persistence rates were 52% for women and 62% for men,” Dr Pina Vegas said. “Persistence decreased markedly over time in both sexes to 27% and 39% respectively at the end of the third year, although in varying proportions by therapeutic class.”

After adjustments, persistence was statistically lower in women than in men for TNFi and IL17i, but not for IL12/23i, IL23i and JAKi. Similar results were seen among patients receiving first-line therapy.

Dr Pina Vegas stated, “This highlights the need for sex- and gender-based studies to better understand the underlying mechanisms, but also for face-to-face studies with sex-stratified analyses to optimize the management of PsA patients and achieve the ambitious goal of personalized medicine in the coming years.”

Pina Vegas L. 0779: Influence of sex on the persistence of different classes of targeted therapies for psoriatic arthritis: a cohort study of 14,778 patients from the French Health Insurance Database (SNDS) Presented at: American College of Rheumatology Convergence. November 12, 2023. San Diego, California.