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!