Gender Gaps Found in Timing of RA Treatment Initiation
METHODOLOGY:
Researchers conducted a multicenter observational study using data from a Spanish registry to assess gender differences in clinical characteristics and in the timing of b/tsDMARD initiation in patients with RA.
They included 3384 patients with RA (78.1% women) who started their first b/tsDMARD between January 2000 and October 2023.
The main outcomes included the time from RA diagnosis to initiation of the first b/tsDMARD and disease activity at treatment initiation, which were compared by sex.
The analysis stratified treatment initiation periods according to the emergence and marketing of different drugs during the study: Up to December 2006, January 2007-December 2016, and after January 2017.
TAKEAWAY:
Women had a lower mean age at treatment initiation than men (54.8 vs 57.0 years; P < .001) but a longer disease duration (mean, 7.3 vs 6.7 years; P = .031).
< .001) but a longer disease duration (mean, 7.3 vs 6.7 years; = .031). Men had a higher body mass index and more comorbidities, whereas women were more likely to have Sjögren syndrome and osteoporosis.
At treatment initiation, women had a higher Disease Activity Score 28–Erythrocyte Sedimentation Rate than men; however, no difference was observed in Disease Activity Score 28–C-reactive protein.
Gender differences in disease duration before treatment initiation were especially notable in women from 2017 onward (hazard ratio, 0.9; P = .026). A longer RA duration before treatment was observed in women, older patients, and those on other conventional synthetic DMARDs (excluding methotrexate), whereas smokers, individuals with obesity, and those receiving methotrexate or glucocorticoids began treatment earlier.
IN PRACTICE:
"The delay in treatment initiation in women despite a higher activity rate merits reflection," the authors of the study wrote.
SOURCE:
This study was led by Paloma Vela-Casasempere, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain. It was published online on May 14, 2025, in Arthritis Research & Therapy .
LIMITATIONS:
Only the covariates available in the registry were included in this study, potentially missing other confounding factors. Sex was recorded as a dichotomous variable (male/female), without accounting for self-identified gender.
DISCLOSURES:
The registry was supported by the Spanish Agency of Drugs and Medical Devices, Biogen, Bristol-Myers and Squibb, and others. Several authors reported receiving grants or contracts, consulting fees, honoraria, or travel support from various pharmaceutical companies, including Novartis and Pfizer.
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