Sex-Based Differences in axSpA Treatment Response - EMJ

Sex-Based Differences in axSpA Treatment Response

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RECENT study highlights sex differences in disease activity measures and treatment responses among patients with axial spondylarthritis (ax SpA), potentially impacting the assessment of tumour necrosis factor alpha inhibitors (TNFi) effectiveness.

Researchers aimed to explore whether there are significant differences between male and female patients in disease activity measures for axSpA and to understand their influence on evaluating TNFi treatment responses. The study, utilised data from the Korean College of Rheumatology Biologics and Targeted Therapy (KOBIO) registry, comparing changes in Bath Ankylosing Spondylitis Disease Activity Score (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) levels at baseline and one year after TNFi initiation in 1,753 patients, of whom 1,343 (76.6%) were male.

At baseline, the mean BASDAI and ASDAS scores were 5.98 and 3.6, respectively. Over the one-year period, changes in BASDAI scores were significantly associated with sex (𝛽 = 0.343, p = 0.011), indicating that male and female patients experienced different disease activity levels. However, ASDAS scores showed no significant sex-based response (𝛽 = 0.079, p = 0.235).

When evaluating the effectiveness of TNFi treatment after one year, male patients were more likely to be deemed as having an effective response based on BASDAI criteria (ΔBASDAI ≥ 50% or ≥ 2; OR 1.7, 95% CI 1.2–2.406). Conversely, the ASDAS criteria (ΔASDAS ≥ 1.1) showed no significant sex difference in treatment response (OR 0.993, 95% CI 0.678–1.455).

The results show significant differences in disease activity measured by BASDAI and ASDAS between male and female patients. BASDAI scores indicate substantial differences in disease activity changes post-TNFi treatment, while ASDAS scores do not. Which suggests that TNFi treatment effects might be interpreted differently based on the disease activity measure used, highlighting the need for sex-specific considerations in axSpA treatment.


Lee S et al. Sex-specific disparities in disease activity scores among patients with axial spondyloarthritis and their implications for evaluating the response to tumor necrosis factor alpha inhibitor therapy. Arthritis Res Ther. 2024;26

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