Association of Sex and Systemic Therapy Treatment Outcomes in Psoriasis

A Two-country, Multicentre, Prospective, Noninterventional Registry Study

J.-T. Maul; M. Augustin; C. Sorbe; C. Conrad; F. Anzengruber; U. Mrowietz; K. Reich; L.E. French; M. Radtke; P. Häusermann; L.V. Maul; W.-H. Boehncke; D. Thaçi; A.A. Navarini

Disclosures

The British Journal of Dermatology. 2021;185(6):1160-1168. 

In This Article

Abstract and Introduction

Abstract

Background: Few systematic data on sex-related treatment responses exist for psoriasis.

Objectives: To evaluate sex differences with respect to systemic antipsoriatic treatment.

Methods: Data from patients with moderate-to-severe psoriasis in the PsoBest or Swiss Dermatology Network of Targeted Therapies (SDNTT) registries were analysed. Treatment response was defined as achieving a ≥ 75% reduction in Psoriasis Area and Severity Index (PASI 75) or PASI ≤ 3 at treatment months 3, 6 and 12, supplemented by patient-reported outcomes [i.e. Dermatology Life Quality Index (DLQI) ≤ 1 and delta DLQI ≥ 4].

Results: In total, 5346 patients registered between 2007 and 2016 were included (PsoBest, n = 4896; SDNTT, n = 450). The majority received nonbiological treatment (67·3% male, 69·8% female). Women showed slightly higher PASI response rates after 3 (54·8% vs. 47·2%; P ≤ 0·001), 6 (70·8% vs. 63·8%; P ≤ 0·001) and 12 months (72·3% vs. 66·1%; P ≤ 0·004). A significantly higher proportion of women achieved a reduction in DLQI ≥ 4 [month 3: 61·4% vs 54·8% (P ≤ 0·001); month 6: 69·6% vs. 62·4% (P ≤ 0·001); month 12: 70·7% vs. 64·4% (P ≤ 0·002)]. Regarding PASI ≤ 3, women on biologics showed a significantly superior treatment response compared with men at 3 (57·8% vs. 48·5%; P ≤ 0·004) and 6 months (69·2% vs. 60·9%; P ≤ 0·018). Women in the nonbiological treatment group had a significantly better treatment response (PASI response, PASI 75 and PASI ≤ 3) over 12 months compared with men.

Conclusions: We provide evidence that women experience better treatment outcomes with systemic antipsoriatic therapy than men.

Introduction

Two and half per cent of the German and the Swiss populations are affected by psoriasis; about half of patients are women.[1–5] A 2019 analysis of sex-specific patient needs revealed that women show a higher burden of disease in psoriasis and have higher expectations of treatment.[6] Given these sex differences in burden and treatment needs, the question arises of whether responses to treatment may also be sex-dependent, in particular those related to patient-reported outcomes (PROs). No antipsoriatic drug currently used provides different dosing regimens related to sex. Moreover, most of the antipsoriatic medications are applied independently of weight, regardless of the fact that women, on average, have a lower body mass index (BMI) than men. Hence, differences in antipsoriatic systemic treatment outcomes cannot be ruled out. However, there is a scarcity of systematic data specifically evaluating sex differences in treatment response.[7–11] In a large Swedish study (n = 5348), men presented with a significantly higher median Psoriasis Area and Severity Index (PASI) than women (7·2 vs. 5·4; P < 0·001). The therapy responses in men and women were not addressed.[1] Gupta and Gupta did not find any sex differences in a cohort of 215 patients, when comparing age and sex differences on the impact of psoriasis on quality of life (QoL).[12] Age and sex affected some aspects of psoriasis-related psychosocial morbidity. No sex differences (P ≤ 0·05) were observed in the frequency of items related to appearance and socialization; however, men had a higher work-related stress level because of their disease.[12] With regard to psoriatic arthritis (PsA), no difference between men and women was seen in a cohort of 110 patients. When stratified for dactylitis, enthesitis, inflammatory back pain, involvement of the distal interphalangeal joint, oligoarthritis and duration of arthritis, there was also no difference in outcomes. However, women twice as often had polyarthritis (20% vs. 40%; P < 0·05).[13] In contrast, there are also data to suggest that males are at higher risk for PsA than females.[14]

The aim of our study was to investigate whether there was a difference in treatment response between women and men with moderate-to-severe psoriasis.

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