Gender Differences in SpA Save

The ACR Convergence 2024 meeting provided its attendees with vast information about disease pathophysiology, diagnosis and treatment covering both clinical and basic sciences. One of the hot topics during the meeting was gender differences in SpA. Three abstracts presented addressed issues related to these differences particularly in the aspects of treatment response and disease activity.

In the PREDICT-SpA study (abstract 0571) by Dr. Hamroun and colleagues, the influence of gender on disease activity assessment tools and the ability of these tools to discriminate the Patient Acceptable Symptom State (PASS) was evaluated. Findings showed that in the overall population, BASDAI, ASDAS-CRP and PGA performed well in discriminating PASS among the genders. BASDAI scores were seen to have better discriminating performance in females.

Putting this into perspective, the results may provide a practical consideration in the creation of future research study designs that will utilize appropriate gender-matched disease activity assessment tools.

A systematic review and meta-analysis by Dr. Chaudhary et al (abstract 0599) aimed to compare the efficacy of biologics among men and women with axSpa from both clinical trials and real-world studies. The results showed that male patients who were treated with biologics were more likely to achieve BASDAI 50 and ASDAS low disease activity response than females.

Conversely, another systematic literature review and meta-analysis from the group of Dr. Angel Gao (abstract 1471) assessed sex-related differences in the efficacy and safety endpoints of advanced therapies in axSpA. According to their findings, female patients were significantly older, had higher BMI and higher baseline BASDAI scores. In contrast, male patients had higher CRP, HLA-B27 positivity and were more likely to achieve an ASAS40 response. The latter was significantly observed with the use of IL-17 inhibitors and TNF inhibitors. Additionally, male patients with nr-axSpA were more likely to achieve efficacy endpoints compared with r-axSpA patients.

A variety of factors may influence these differences among the genders and knowing these can inform us of the proper approach to our patients. Further research will help elucidate the expanding complexities of the disease and how gender differences can impact outcomes and response to treatment.