Influence of gender and age on effectiveness of bDMARDs in axSpA: a meta-analysis

bDMARDs improve ASAS40 response in patients with axial spondyloarthritis (axSpA), regardless of gender or age. Researchers conclude this on the basis of a meta-analysis. However, response to treatment was more pronounced in male and younger patients. Furthermore, women with r-axSpA had a greater response than women with nr-axSpA, while no relevant difference was observed in men.

In this meta-analysis, the variation in the effectiveness of biological and targeted synthetic DMARDs (b/tsDMARDs) was studied between genders and at different age stages in patients with axSpA. To this end, randomized controlled trials published on Pubmed, Scopus and Embase before August 10, 2023, testing the effectiveness of b/tsDMARDs in axSpA, were systematically reviewed. The ASAS40 response was used as the primary outcome measure.

Only 1 study that met the inclusion criteria involved a tsDMARD and was excluded from further analysis. 9 studies of bDMARDs, involving 4127 patients, were included in the analysis. Relative to placebo, both male (OR 3.14; 95% CI 2.66-3.70) and female patients (2.32; 1.82-2.82) and both younger (4.00; 2) .50-6.40) and older patients (2.21; 1.15-4.22) had a significantly better response to bDMARDs. The effectiveness was more evident in men (1.89; 1.56-2.30) and younger patients (2.07; 1.42-3.02). A subgroup analysis showed that the sex difference in effectiveness was more pronounced in non-radiographic axSpA patients (nr-axSpA) (P_{heterogeneity} 0.03; I² 78.1%). Men with radiographic-axSpA (r-axSpA) and nr-axSpA had a similar response to bDMARDs (P_{heterogeneity} 0.87; I² 0%), while women with r-axSpA showed a greater response than those with nr-axSpA (_{Pheterogeneity} 0.005; I² 87.4%).

Source:

Xie Y, Liu Y & Wu Q. Effect of gender and age on bDMARD efficacy for axial spondyloathritis patients: a meta-analysis of randomized controlled trials. Rheumatology (Oxford). 2024 Feb 6. Online ahead of print.