Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Women with Rheumatoid Arthritis Have Better Responses to Anti-TNF Therapy in the First Year, but Men Respond Significantly Better in the Long-Term Results From the Danish DANBIO Registry

Jawaheer1,  Damini, Olsen1,  Jorn, Hetland2,  Merete L.

UCLA, Los Angeles, CA
DANBIO, Copenhagen Univ. Hospital, Copenhagen, Denmark

Purpose:

To investigate gender differences in anti-TNF treatment outcomes over time in rheumatoid arthritis (RA) patients.

Method:

We investigated treatment outcomes over 54 months in men and women with RA who initiated anti-TNF therapy between January 2003 and June 2008 in Denmark. Demographic and clinical data collected every 6 months by trained rheumatologists from hospitals* nationwide were documented in the DANBIO Registry. Gender differences in disease features at baseline were examined using Chi-square tests for categorical variables, and the Mann-Whitney and t-tests for continuous variables. Using a generalized estimating equations (GEE) model for repeated measures, we also examined changes in disease outcomes in men and women over time, including ACR20 and EULAR responses, adjusting for baseline values of the disease activity score (DAS28CRP4), disease duration and anti-TNF treatment.

Results:

At initiation of anti-TNF therapy (baseline), men (n=656) and women (n=1,852) had equally active disease (mean±SD DAS28CRP4: 5.1±1.3). Men had significantly later age at diagnosis, shorter disease duration, and higher C-reactive protein (CRP) (table 1). Women had worse disability (HAQ-DI), pain visual analogue scale (VAS), patient global scores, and fatigue VAS, and more tender joints. There were no differences in physician global scores, swollen joint counts and in proportions of men and women with erosions (73%). The GEE models revealed that, although women showed better responses during the first 12 months of treatment, in the longitudinal setting, men were more likely to achieve an ACR20 treatment response as well as a EULAR "good" response; these differences were statistically significant, and of clinical relevance, from 3 years onwards (ACR20: p=0.037, EULAR: p=0.035) (fig 1). Loss to follow up was similar in both genders and hence did not account for differences in response. No significant gender differences were observed in DAS28CRP4 scores, HAQ-DI, pain VAS, patient global scores and fatigue VAS over time, although women consistently had higher mean scores.

Table 1.

Baseline characteristicsAll patients (n=2,508)Men (n=656)Women (n=1,852)p value
  mean ± SD, or median 
Age at diagnosis45.3 ± 14.746.5 ± 13.345.0 ± 15.20.01
Disease duration10.6 ± 9.99.6 ± 9.111.0 ± 10.20.003
DAS28CRP45.1 ± 1.35.1 ± 1.35.1 ± 1.30.25
Swollen joint count7770.73
Tender joint count8890.0008
CRP1416140.008
HAQ-DI1.31.01.4<0.00005
Pain VAS5956600.05
Patient global score6462650.03
Fatigue VAS5747600.06

Figure 1. Proportions of men and women who achieve an ACR20 or a "good" EULAR response over time

Conclusion:

In this RA cohort, women had a better response to anti-TNF therapy for the first year of treatment. However, in the long-term, men responded better, with a significantly better response after 3 years of treatment.

*ÅAlborg, ÅArhus, Bispebjerg, Esbjerg, Frederiksberg, Gentofte, Glostrup, Gråsten, Hjørring, Holbæk, Holstebro, Horsens, Hvidovre, Hørsholm, Kolding, Næstved/Nykøbing Falster, Odense, Randers, Rigshospitalet, Roskilde/Køge, Silkeborg, Slagelse, Svendborg/Fåborg, Vejle and Viborg

To cite this abstract, please use the following information:
Jawaheer, Damini, Olsen, Jorn, Hetland, Merete L.; Women with Rheumatoid Arthritis Have Better Responses to Anti-TNF Therapy in the First Year, but Men Respond Significantly Better in the Long-Term Results From the Danish DANBIO Registry [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1601
DOI: 10.1002/art.26675

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