In psoriatic arthritis, women show a decreased response in the resolution of pain, enthesitis, dactylitis, and ACR response rates, Micheala Koehm, MD, enlightened her audience during her research presentation at ACR Convergence on November 13. Through her research, she also proved that the ustekinumab+MTX combinational treatment wasn’t as effective for women as it was for men in the treatment of enthesitis and dactylitis.

Dr Koehm is a practicing rheumatologist at the Goethe-University in Frankfurt, Germany.

“Subgroup analysis from different clinical trials and real-world data suggest, that there are differences in baseline characteristics, clinical phenotypes, and treatment responses in female patients compared to males,” Dr Koehm said. Especially in psoriatic arthritis, which is a heterogeneous disease, only little is known about gender differences, she said to explain the premise of the randomized, placebo-controlled trial she conducted with her fellow German colleagues.

While 173 patients with active PsA were randomly assigned ustekinumab+MTX (new or ongoing), 166 patients with active PsA were randomly assigned ustekinumab+placebo. The patients were divided into males (58.4%) and females (41.6%). Throughout the trial, the researchers compared demographic data, disease activity status, enthesitis, dactylitis count, quality of life and function between the two groups. Response rates (pain response, ACR response) were evaluated at week 24.

Throughout the trial, the researchers noted that the demographic data, the years since the onset of PsA, age and body mass index were consistently well-balanced between the groups. However, skin involvement (body surface area [BSA] and psoriasis area and severity index [PASI]) were both higher in the ustekinumab+MTX group, especially in the women with a BSA of 9.6% and PASI of 5.3.

While enthesitis was more frequent among women, dactylitis was more frequent among men.

The treatment response features varied widely across men and women, Dr Koehm noted. The reduction in pain and ACR response rates were both higher for men than for women, which meant women suffered longer bouts of enthesitis, dactylitis, and pain during their disease journey.

“Different from males, females seem not to benefit from a ustekinumab+MTX combinational treatment for the improvement of enthesitis and dactylitis,” Dr Koehm concluded.

—Priyam Vora

Reference:
Koehm M. Poster 1601. Female Psoriatic Arthritis Patients Show Differences in Treatment Response to IL12/23 Inhibition in Combination with or Without MTX Compared to Male – Results from a Multicenter Investigator-initiated Randomized Placebo-controlled Clinical Trial. Presented at: American College of Rheumatology Convergence. November 13, 2022.