New evidence presented at the 2022 EULAR Congress reveals sex differences in physiology, disease presentation, and response to treatment in people with axial spondyloarthritis (axSpA), as well as the impact of non-steroidal anti-inflammatory drugs (NSAIDs) in people with radiographic disease.
axSpA is a chronic inflammatory rheumatic disease that mainly affects the spine and sacroiliac joints. It can cause significant pain and disability. Many different agents are available to treat people with axSpA, but they do not always work for everybody.
Previously, pooled data from randomized controlled trials have demonstrated reduced treatment efficacy of a tumour necrosis factor inhibitor (TNFi) in females compared to males with ankylosing spondylitis.
Dr Pasoon Hellamand and colleagues sought to validate prior studies using data from a large multinational cohort based on real-life clinical practice. In total, 6,451 axSpA patients were assessed for treatment response. Analysis of the results showed that the probability for females to have a clinically important improvement was 15% lower compared to males. In addition, TNFi retention rates were significantly lower in females. Recognizing these sex differences is relevant for customized patient care, and may improve patient education.
Another group working on axSpA looked at whether treatment with NSAIDs is associated with retardation of radiographic spinal progression. To date there have been conflicting reports: previous analysis of GESPIC – the GErman SPondyloarthritis Inception Cohort – showed that higher NSAID intake may retard new bone formation in radiographic axSpA. However, it remained unclear whether cyclooxygenase-2 selective inhibitors (COX2i) might have a stronger effect than non-selective ones, and if the effect could also be observed in non-radiographic disease.
Dr Murat Torgutalp’ et al. looked at 243 patients with early axSpA from GESPIC to work out the association between NSAID intake and radiographic spinal progression over 2 years. Overall, the results showed that higher NSAID intake is associated with lower radiographic spinal progression, particularly in patients with radiographic axSpA. COX2i might possess a stronger inhibitory effect on radiographic progression as compared to non-selective NSAIDs.