IMPACT OF SEX AND COMORBIDITIES ON TNFi TREATMENT IN PATIENTS WITH ENTEROPATHIC SPONDYLOARTHRITIS: A CROSS-SECTIONAL STUDY Arianna D’Antonio, MD Reumatologia Università di Roma “Tor Vergata”
IMPACT OF SEX AND COMORBIDITIES ON TNFi TREATMENT IN PATIENTS
WITH ENTEROPATHIC SPONDYLOARTHRITIS: A CROSS-SECTIONAL STUDY
Arianna D’Antonio, MD
Reumatologia
Università di Roma “Tor Vergata”
Case Report
S.D.S., man, 54 yrs-old
S.D.S., woman, 54
yrs-old
Smoker, BMI: 26 PsO since the age of 25 yrs-old (1990) (scalp, elbows, umbilicus, and lumbar region)
In 2007, she presented GI symptoms (diarrhoea, bloody stools). Blood tests: mild anemia and increase of CRP levels (32 mg/dl).
Diagnosis of extensive UC (Mayo score 8)
Ev metilprednisolone 60 mg than os PDN 50mg (than 25 mg)+ local mesalazine + iron supplementation
After 4 months, she presented joint symptoms Tender and swollen knees and Left talalgiaBlood tests: PCR 0.8 mg/dL, HLA B27 + DAPSA 17.8; PASI 25.8
ESpA and severe Psoriasis
COXIB, Methotrexate 20 mg/week + PDN 25mg + TNFi (IFX)
PsO!Right Knee arthritisLeft Achille’s tendon enthesitisContinuous inflammatory involvement of the with mucosal hyperemia and friability, aftoid ulcerations.
2008: Infliximab (5 mg/kg ev at 0, 2, and 6 weeks, followed by 5 mg/kg every 8 weeks)MTX suspended for high liver tests
From 2008 to Jan 2019: clinical remission
Therapeutical approach
TRAUMA + SKIN and JOINT Relapse
SSZ 2 gr, Prednisone 25 mg, Local injections
Start new bDMARD + PsY consultation
Depression in SpAPathogenesis
Chimenti MS et al. 2020
Therapeutical approach
Psychotherapy for target symptoms and lifestyle intervention
MULTIDISCIPLINARY WORK-UP
Approccio locale di Tor Vergata
Aim of the Study
ESpA patients treated with TNFi
1. Determine effectiveness andreasons of TNFi discontinuations
2. Determine whether comorbiditieslead to different TNFi response
3. Determine whether sex lead todifferent TNFi response
• Cross-sectional retrospective study on outpatients
ESpA patients treated with TNFi referred to the
combined GI–Rhe clinic of the University of Rome Tor
Vergata.
• TNFi treatments line/s, effectiveness and reasons of
discontinuations were evaluated at baseline (T0), at 6
(T6), 12 (T12), 18 (T18) and 24 (T24) months of therapy.
• SJC, TJC, ESR, CRP, HAQ-S, BASDAI, ASDAS CRP, BASFI,
VAS Pain, PG-VAS.
• Patients who were failure to at least two TNFi were
considered as “multifailure”.
Patients and Methods
* Esclusion Criteria:• Patients with not
inflammatory pain• Demographic and clinical
data not available• Age < 18 years
190 IBD patients
120 patients included
63,16 % *
200 TNFi treatment evalueted
Period: November 2019-August 2021
F: 77M: 43
Results
• Rad-SpA was more common in men (p=0.03)
• Trend of CRP was higher in male than female gender
• Trend of BASDAI, BASFI and HAQ-S were higher in female than male gender
• Hypertension and anemia were more prevalent in men than women (p=0.01; p=0.02, respectively);
• Thyreopathy and psychiatric disorders were more common in female than male (p=0.02; p=0.04, respectively).
• Higher prevalence of failure in women that in men (67.2% vs 39.2%, p=0.0005). Female sex was more multifailure than men (p=0.04)
• Women with psychiatric disorders undergone more lines treatment that men (16.8% vs 4.6%, p=0.01, OR=4).
• Men with hypertension, were more multifailure compared with women
Results
29%
15%39%
9%8%
Reasons of discontinuations
Adverse events
SpA Inefficacy
IBD Inefficacy
Cancer
Infections
Results
No difference was observed between genders, TNFi treatment and UC/CD.
At T6, 7.5% of patients had acute adverse reaction; atT12, 14.2% of patients had IBD inefficacy.
At T24, IBD and/or SpA secondary inefficacy was themain cause of TNFi discontinuation compared with othercauses (58.4% vs 41.6%; p=0.04), mostly in female cohort(p=0.04).
Results: INFLIXIMAB treatment
In male sex:• Improvement of CRP at T6 (p= 0.013)
• Improvement of ASDAS CRP at T24 (P= 0.017)
• Improvement of BASDAI at T18 and T24 (P= 0.02 and P=0.016)
In female sex:• Improvement of ASDAS CRP at T18 and T24 (p= 0.02 and
P=0.018)
*
Results: INFLIXIMAB treatment
CRP was higher in male than female at T18 and T24 (p= 0.03 and 0.04)
BASDAI was higher in female than male at baseline(P= 0.035)
Results: ADALIMUMAB treatment
In male sex:• Improvement of CRP at T12, T18 and
T24 (p= 0.0004; p=0.006; p= 0.013)
In female sex:• Improvement of HAQ-S at T18 (p= 0.03)
Results: ADALIMUMAB treatment
HAQ-S was higher in female than male at T6, T12 and T24 (p= 0.022; p= 0.024; p= 0.028)
BASDAI was higher in female than male at T24 (P= 0.038)
ASDAS CRP was higher in female than male at T12 (P= 0.04)
Different prevalence of comorbidities according to sex
Higher prevalence of failure in women that in men
Comorbidities could influence TNFi response in ESpA patients, advisingdifferences among woman and men
Different sex response to treatment misured by clinimetric index
Take-home messages
Identify sex differences and comorbidities in TNFi response represent a major challange for a personalize sex-oriented
therapeutic approach in ESpA patients.
PTV Combined Gastro-Rheuma Clinic“GI–Rhe” Outpatients Clinic
Grazie!