ARE WOMEN WITH RHEUMATOID ARTHRITIS REALLY LESS LIKELY TO ACHIEVE REMISSION WITH BIOLOGICS? A COHORT STUDY IN THE SWISS CLINICAL QUALITY MANAGEMENT COHORT

BackgroundRheumatoid arthritis (RA) affects women three time more frequently than men. However, compared to men, women may have a lower likelihood of achieving clinical response, but data related to this topic are controversial.ObjectivesWe aimed to compare the likelihood of achieving remission across men and women with RA, who started their first biologic or targeted synthetic disease-modifying anti-rheumatic drug (b/tsDMARDs).MethodsThis observational cohort study in the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) registry included adult RA patients who started their first b/tsDMARDs (from 1997 to 31/April/2018). Patient characteristics at start of the b/tsDMARD were compared between men and women. Subsequently, logistic regression was used to assess the likelihood of achieving remission during the first year after b/tsDMARDs start, defined by disease activity score 28 (DAS28) <2.6, in men compared to women (reference group). Secondary analyses were adjusted for age and seropositivity as prognostic factors, and we investigated the role of potential mediators or factors that could explain the findings from the main analysis.ResultsThe study included 3722 RA patients, of which 2839 (76.3%) were women and 883 (23.7%) were men. Compared to women, men were older at diagnosis and start of b/tsDMARDs, and had shorter time from diagnosis to their first b/tsDMARD (3.4 vs 5.0 years, p<0.001). At baseline (b/tsDMARD initiation), women had significantly more active disease activity (DAS28) and worse patient-reported outcomes (Health Assessment Questionnaire, tender joints). Concomitant osteoporosis and depression/anxiety were more frequent among women, while men had more frequent diabetes and prior or current smoking record. Physician’s global disease assessment and swollen joints were similar across groups. Compared to women, men were 21% more likely to achieve DAS28-remission, with an odds ratio (OR) 1.21, 95% confidence interval (CI) 1.02-1.42. Secondary analyses adjusting by for age and seropositivity did not change the findings (adjusted OR 1.24, 95% CI 1.05-1.46). Our analyses of potential mediators suggested that the observed effect may be explained by the shorter disease duration and lower DAS28 at treatment initiation in men vs women.ConclusionMen started b/tsDMARDs at an earlier stage of disease than women, particularly regarding disease duration and disease activity (DAS28) at b/tsDMARD initiation, and they presented higher odds of remission. This highlights the importance of an earlier treatment, and it suggests to target an earlier stage of disease in women to match the benefits observed in men.AcknowledgementsWe thank all patients and rheumatologists contributing to the SCQM registry, as well as the entire SCQM staff. A list of rheumatology offices and hospitals which contribute to the SCQM registry can be found at http://www.scqm.ch/institutions. A list of financial supporters of SCQM can be found at http://www.scqm.ch/sponsors. We would like to add a personal thank you to Axel Finckh (University Hospitals of Geneva) for his input regarding the database. AMB acknowledges that her professorship is partly endowed by the Swiss National Pharmacy Association (PharmaSuisse) and the ETH Foundation.Disclosure of InterestsNone declared.