Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

A Retrospective Analysis of Anti-TNF Treatment of 146 Ankylosing Spondylitis Patients According to Gender.

Yalcinkaya,  Yasemin, Pehlivan,  Özlem, Omma,  Ahmet, Artim-Esen,  Bahar, Erer,  Burak, Huseyinsinoglu,  Nihat, Kamali,  Sevil


To investigate disease characteristics according to gender differences in patients with ankylosing spondylitis (AS) receiving anti-TNF therapy.


This report evaluated retrospectively data of 146 patients with AS fulfilling modified New York criteria followed between 2001 and 2010, including demographics, symptoms, physical examinations, laboratory findings, complications and treatment details. Student's t test was used for comparison.


The mean age of patients was 40.1 and 70% were males. Age at symptom onset, delay in diagnosis, disease duration(year) were 24.4, 5.8 and 15.8 respectively. The mean age at symptom onset(year) was significantly low in males (22.7 vs 28.3, p<0.01). The time interval between the onset of symptoms and anti-TNF therapy was >10 years in 89(61%), 5–10 years in 32(22%) and <5 years in 25(17%) patients. Females receiving anti-TNF therapy within 5 years were significantly high (23 vs 12%).

The mean duration of treatment (month) was 23.2 for infliximab(IFX)(n:79), 21.4 for etanercept(ETN)(n:85) and 19.8 for adalimumab(ADA)(n:20). Switching to a second anti-TNF agent was 18%(n:26) and to a third agent 3%(n:5) for inefficacy (n:27), infusion reaction (n:5), uveitis (n:2), pulmonary tuberculosis(n:1) and psoriasis (n:1). Sixteen% of females and 19% of males required a second, 5% of females and 3% of males required a third agent (Table-1).

Initiation of anti-TNF agent due to axial involvement and high acute phase response were similar in females and males (96 vs 99% and 48 vs 52%). Peripheral arthritis and uveitis were more frequent in females (66 vs 37% and 4.5 vs 2%) whereas proteinuria/amyloidosis were more frequent in males(4 vs 2%).

In 12 patients (Table 1), dose reduction and cessation of anti-TNF therapy due to remission waspossible. Dose reduction was higher in males (7/102, 7% vs 1/44, 2%) and cessation was higher in females (3/44, 7% vs 1/102, 1%). The mean duration of treatment (month) in this group was 21 for infliximab(n:5) and 25.3 for etanercept (n:7); the time interval between the onset of symptoms and anti-TNF therapy was >10 years in 7(58%)(5 male), 5–10 years in 1(8%)(male) and <5 years in 4(33%)(2 male) patients. Termination due to complications (3 infusion reactions, 1 pulmonary tuberculosis, 1 hepatotoxicity, 1 pneumonia, 1 psoriasis) was significantly higher in males (n:6, 5.9% vs n:1, 2.3%).

Table 1. Details of anti-TNF treatment

 Females (n:44)Males (n:102)
Dose reduction of anti-TNF therapy  
  Satisfactory response1 (2%)7 (7%)
Cessation of anti-TNF therapy  
  Remission3 (7%)1 (1%)
  Complications1 (2.3%)6 (5.9%)
Switching to a second agent (n:26)7 (16%)19 (19%)
  IFX ® ETN (n:13)310
  ETN ® IFX (n:6)24
  IFX ® ADA (n:3)-3
  ADA ® IFX (n:2)11
  ETN ® ADA (n:1)1-
  ADA ® ETN (n:1)-1
Switching to a third agent (n:5)2 (5%)3 (3%)
  ETN ® IFX® ADA (n:3)12
  IFX ® ADA® ETA (n:1-1
  IFX ® ETA® ADA (n:1)1-


In AS patients receiving anti TNF therapy, males were younger and had dominantly axial involvement. The mean duration of anti-TNF treatment was 27,8 months and similar for each agent (ETN /ADA / IFX). Females received anti-TNF therapy earlier but both male and female patients had satisfactory responses to anti TNF treatment. Switching between anti TNF agents was similar in males and females. Complications related with treatment were frequent in males.

To cite this abstract, please use the following information:
Yalcinkaya, Yasemin, Pehlivan, Özlem, Omma, Ahmet, Artim-Esen, Bahar, Erer, Burak, Huseyinsinoglu, Nihat, et al; A Retrospective Analysis of Anti-TNF Treatment of 146 Ankylosing Spondylitis Patients According to Gender. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1328

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