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Study Reveals Gender Disparity in Anti-TNF Use for Rheumatoid Arthritis
June 20, 2007
Findings reported here at the Annual European Congress of Rheumatology
(EULAR), reveal a treatment disparity between female and male patients
with rheumatoid arthritis (RA).
Data from a study at the Karolinska Institute, Sweden, show
that women receive anti-TNFs at a higher perceived level of disease
activity and when they are reporting more severe pain than their male
Whilst some disease activity measurements were found to be
higher for women than men, and self-reported disease activity by the
patients themselves echoed this, the physicians' global assessments
showed little difference between the level of disease in the men and
women of the study group.
Lead researcher Dr. Ronald van Vollenhoven comments, "Women are
known to have consistently worse long-term outcomes in rheumatoid
arthritis than men. To date, it has been unclear if this is due to
factors intrinsic to the disease or because of gender-related
prescribing. Our study does not show a gender-bias as such, but does
indicate that physicians to some extent 'discount' the subjective
measures of disease activity, which we found to be higher in women, and
let their decisions be driven almost solely by objective markers of the
disease. As a result, women are receiving anti-TNFs at a higher level
of disease symptoms than men. Because the goal of any treatment for RA
must be to relieve the patients suffering, it is not clear that this
approach is the right one."
The study analysed baseline variables for the patients on RA
who were started on anti-TNF treatment in the STURE Registry (the
Stockholm TNF-alpha follow-up registry). When anti-TNFs were first
prescribed to the 644 study participants, the level of their RA
severity was logged, as measured according to Disease Activity Scale 28
(DAS28) which takes into account the severity of disease across the 28
joints most commonly affected by RA.
Each participant's Erythrocyte
Sedimentation Rate (ESR), which measures the level of inflammation, was
also noted along with their Swollen Joint Count (SJC) and Tender Joint
Count (TJC). Furthermore, both patients and their physicians completed
a global assessment of disease activity, pain and physical activity
(five point scale questionnaire).
DAS28 scores at initiation of anti-TNF treatment were
found to be significantly higher for women than for men (DAS28 was 5.53
for women, 5.04 for men, P =.0006) and women had higher Tender Joint
Counts (9.62 compared to 8.41 for males, P =.066). The women in the
study also had significantly higher ESR scores, although the authors
suggest that this could be explained in part by the female hormone
oestrogen, which affects tends to raise the ESR.
With regard to the more subjective self-reporting on
the disease, through the patient-completed global health ratings, women
also reported significantly worse global health (as measured by VAS and
HAQ-disability index). However, the physician-completed global health
ratings were equivalent for men and women.
Dr. Ronald van Vollenhoven comments, "This study shows
the importance of taking into account both objective and subjective
measurement scores in treatment decisions. It is our hope that these
data will help redress this imbalance and ensure equal prescribing and
disease management for all."
SOURCE: The European League Against Rheumatism
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