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Sex differences in patient-reported outcome measures and the association with clinical factors in axial spondyloarthritis patients treated with tumour necrosis factor inhibitors

Hellamand, Pasoon ; van de Sande, Marleen G.H. ; Nurmohamed, Michael T. ; van Vollenhoven, Ronald F. ; Hollick, Rosemary J. ; Rotariu, Ovidiu ; Rotar, Ziga ; Pirkmajer, Katja P. ; Nordström, Dan and Hokkanen, Anna Mari , et al. (2025) In Rheumatology 64(4). p.1853-1863
Abstract

Objectives: To investigate sex differences in patient-reported outcome measures (PROMs) among axSpA patients initiating their first TNFi and identify factors contributing to these disparities over the follow-up. Methods: Data were included from 15 EuroSpA registries and consisted of axSpA patients initiating their first TNFi, with ≥2 measurements for each analysed PROM (BASDAI and BASFI, scale 0–100) taken at any time point. Linear mixed models were employed to analyse sex differences in PROMs over 24 months and to evaluate how baseline characteristics were related to the observed sex differences. Results: We analysed 13 102 (38% women) in the BASDAI analyses and 10 623 (38% women) in the BASFI analyses. At follow-up, mean sex... (More)

Objectives: To investigate sex differences in patient-reported outcome measures (PROMs) among axSpA patients initiating their first TNFi and identify factors contributing to these disparities over the follow-up. Methods: Data were included from 15 EuroSpA registries and consisted of axSpA patients initiating their first TNFi, with ≥2 measurements for each analysed PROM (BASDAI and BASFI, scale 0–100) taken at any time point. Linear mixed models were employed to analyse sex differences in PROMs over 24 months and to evaluate how baseline characteristics were related to the observed sex differences. Results: We analysed 13 102 (38% women) in the BASDAI analyses and 10 623 (38% women) in the BASFI analyses. At follow-up, mean sex differences in BASDAI increased from 4.3 units at baseline (95% CI, 3.5–5.1) to 8.0 (7.2–8.8) at 6 months, and in BASFI from 2.2 (1.4–3.1) to 4.6 (3.6–5.5), with consistently worse scores in women. Baseline characteristics could not substantially account for the observed sex differences over time; however, the magnitude of the sex differences was reduced by HLA-B27 positivity, longer disease duration, and increased CRP levels, but increased by TNFi initiation in later years and peripheral arthritis. Conclusion: In axSpA patients initiating their first TNFi, baseline sex differences in BASDAI and BASFI increased two-fold after 6 months of treatment and persisted thereafter, with worse scores in women. Several baseline characteristics moderated the sex differences, though none could fully account for them. These findings improve our understanding of sex differences and underscore their importance in axSpA.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
axial spondyloarthritis, patient-reported outcome measures, sex differences, TNF inhibitors
in
Rheumatology
volume
64
issue
4
pages
11 pages
publisher
Oxford University Press
external identifiers
  • pmid:39041780
  • scopus:105002036618
ISSN
1462-0324
DOI
10.1093/rheumatology/keae370
language
English
LU publication?
yes
additional info
Publisher Copyright: © The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.
id
cfcd2292-1609-46fb-a768-5347e260fbf4
date added to LUP
2025-08-22 14:14:17
date last changed
2025-08-22 15:13:40
@article{cfcd2292-1609-46fb-a768-5347e260fbf4,
  abstract     = {{<p>Objectives: To investigate sex differences in patient-reported outcome measures (PROMs) among axSpA patients initiating their first TNFi and identify factors contributing to these disparities over the follow-up. Methods: Data were included from 15 EuroSpA registries and consisted of axSpA patients initiating their first TNFi, with ≥2 measurements for each analysed PROM (BASDAI and BASFI, scale 0–100) taken at any time point. Linear mixed models were employed to analyse sex differences in PROMs over 24 months and to evaluate how baseline characteristics were related to the observed sex differences. Results: We analysed 13 102 (38% women) in the BASDAI analyses and 10 623 (38% women) in the BASFI analyses. At follow-up, mean sex differences in BASDAI increased from 4.3 units at baseline (95% CI, 3.5–5.1) to 8.0 (7.2–8.8) at 6 months, and in BASFI from 2.2 (1.4–3.1) to 4.6 (3.6–5.5), with consistently worse scores in women. Baseline characteristics could not substantially account for the observed sex differences over time; however, the magnitude of the sex differences was reduced by HLA-B27 positivity, longer disease duration, and increased CRP levels, but increased by TNFi initiation in later years and peripheral arthritis. Conclusion: In axSpA patients initiating their first TNFi, baseline sex differences in BASDAI and BASFI increased two-fold after 6 months of treatment and persisted thereafter, with worse scores in women. Several baseline characteristics moderated the sex differences, though none could fully account for them. These findings improve our understanding of sex differences and underscore their importance in axSpA.</p>}},
  author       = {{Hellamand, Pasoon and van de Sande, Marleen G.H. and Nurmohamed, Michael T. and van Vollenhoven, Ronald F. and Hollick, Rosemary J. and Rotariu, Ovidiu and Rotar, Ziga and Pirkmajer, Katja P. and Nordström, Dan and Hokkanen, Anna Mari and Michelsen, Brigitte and Kvien, Tore K. and Glintborg, Bente and Hetland, Merete L. and Østergaard, Mikkel and Loft, Anne G. and Pavelka, Karel and Zavada, Jakub and Castrejon, Isabel and Otero-Varela, Lucia and Gudbjornsson, Bjorn and Palsson, Olafur and Olofsson, Tor and Wallman, Johan K. and Ciurea, Adrian and Nissen, Michael J. and Yildirim, Tuba D. and Onen, Fatos and Codreanu, Catalin and Mogosan, Corina and Santos, Maria J. and Vieira-Sousa, Elsa and Iannone, Florenzo and Frediani, Bruno and Ørnbjerg, Lykke M. and Twisk, Jos W.R. and van der Horst-Bruinsma, Irene E.}},
  issn         = {{1462-0324}},
  keywords     = {{axial spondyloarthritis; patient-reported outcome measures; sex differences; TNF inhibitors}},
  language     = {{eng}},
  month        = {{04}},
  number       = {{4}},
  pages        = {{1853--1863}},
  publisher    = {{Oxford University Press}},
  series       = {{Rheumatology}},
  title        = {{Sex differences in patient-reported outcome measures and the association with clinical factors in axial spondyloarthritis patients treated with tumour necrosis factor inhibitors}},
  url          = {{http://dx.doi.org/10.1093/rheumatology/keae370}},
  doi          = {{10.1093/rheumatology/keae370}},
  volume       = {{64}},
  year         = {{2025}},
}