Impact Of Gender And Comorbidities In Enterophatic Spondyloarthritis: A Cross-Sectional Study

Background:Enteropathic Spondyloarthritis (ESpA) belongs to the group of Spondyloarthritis (SpA) typically associated with inflammatory bowel disease (IBD). SpA are divided into axial (ax) or peripheral disease. Ax-SpA are classified as ankylosing spondylitis (AS) and non-radiographic (nr-) axSpA based on the presence or absence of definite structural changes in conventional radiographs (CR).Objectives:Aim of this study was to determine whether comorbidities and gender could lead to a different response rate to TNF-inhibitors (TNFi) in ESpA patients.Methods:ESpA patients treated with TNFi [adalimumab (ADA) or infliximab (IFX)] were retrospectively evaluated between November 2018 and October 2020 and divided in two cohort according to gender. In addition, TNFi treatments line/s, effectiveness and reasons of discontinuations, as inefficacy, intolerance, acute adverse reaction, development of infections and other causes, were evaluated at baseline (T0), at 6 (T6), 12 (T12), and 24 (T24) months of therapy. Patients who were failure to at least two TNFi were considered as “multifailure”. Statistical analyses were performed using chi square/Fisher tests and variance analysis (SPSS software).Results:120 ESpA patients (M 40.52%; F 40.18%) treated with TNFi were evaluated. Clinical and laboratory baseline (T0) characteristics are summarized in Table 1. AS subtype was more common in men (39.5%) than in woman (14.3%) (p=0.03). Concerning comorbidities, hypertension and anemia were more prevalent in men than women (25% vs 9%, p=0.01; 11.6% vs 1.3%, p=0.02, respectively), while thyreopathy and psychiatric disorders were more common in female than male (11.7% vs 0%, p=0.02; 16.9% vs 4.6%, p=0.04, respectively). No difference was observed between genders in distribution of BMI, smokers, disease duration, HLAB27 positivity and presence of extra-articular manifestations. 202 TNFi treatments (50.9% ADA and 24.3% IFX) were evaluated in 120 patients [74 treatments (36.6%) in 43 men; 128 treatments (63.4%) in 77 women]. Considering treatment effectiveness, higher prevalence of failure was observed in woman that in men (67.2% vs 39.2%, p=0.0005). Moreover, women with psychiatric disorders undergone more lines treatment that men (16.8% vs 4.6%, p=0.01, OR=4). On the other hand, men with hypertension, were more multifailure compared with women (25.6% vs 16.3%, p=0.001, OR=3). No other differences according to gender were found.At T6, 7.5% of patients (n=9) had acute adverse reaction (n=1 with ADA; n=8 with IFX); at T12, 14.2% of patients (n=17) had IBD inefficacy. At T24, secondary inefficacy on IBD and/or SpA was the main cause of TNFi discontinuation compared with other causes (58.4% vs 41.6%; p=0.04), mostly in female cohort (40% vs 20% in woman; p=0.04). Analyzing TNFi effectiveness, CRP and HAQ improvement was noted at T6 (p=0.024 and 0.036, respectively), as ASDAS-CRP and BASDAI (p=0.02 and p=0.013, respectively) and maintained in the following evaluations at T12 and T24. At T24, men shown higher PCR and BASDAI improvement compared with women (p=0.036 and p=0.04, respectively).Conclusion:Data suggest that gender and comorbidities could influenced TNFi response in ESpA patients, advising differences among woman and men. Knowledge of these variable represents a major challenge for a personalized treatment management.Disclosure of Interests:None declared.