Effect of gender and age on bDMARD efficacy for axial spondyloathritis patients: a meta-analysis of randomized controlled trials.

Abstract

To study the therapeutic variations of biological and targeted synthetic disease-modifying antirheumatic drugs(b/tsDMARDs) between genders and across age stages in axial spondyloarthritis (axSpA) patients through meta-analysis. Randomized controlled trials (RCTs), published by Pubmed, Scopus, and Embase before August 10, 2023, testing the efficiency of b/tsDMARDs in axSpA, were searched and systematically reviewed. The Assessment of Spondyloarthritis International Society ≥40% improvement (ASAS40) response was used as the primary outcome of treatment response. : Only one study meet the inclusion criteria was related to tsDMARD, which was excluded from further data combination. Nine studies of bDMARDs, with the involvement of 4127 patients, were included for final analysis. When compared with placebo, both males (OR = 3.14; 95%CI, 2.66-3.70) and females (2.32; 1.82-2.82), younger (4.00; 2.50-6.40) and older (2.21; 1.15-4.22) patients, presented significantly better responses to bDMARDs. Besides, the efficacies were more evident in males (1.89; 1.56-2.30) and younger patients (2.07; 1.42-3.02). Subgroup analysis revealed that gender difference in efficacy was more obvious in non-radiographic-axSpA (nr-axSpA) patients (Pheterogeneity=0.03, I2=78.1%). Moreover, males with radiographic-axSpA (r-axSpA) and nr-axSpA shared similar responses to bDMARDs (Pheterogeneity=0.87, I2=0%), while females with r-axSpA showed greater response than those with nr-axSpA (Pheterogeneity=0.005, I2=87.4%). BioDMARDs were efficient in all axSpA patients regardless of gender or age stage. However, the treatment responses were more evident in male and younger patients. Besides, females with r-axSpA had greater responses than those with nr-axSpA, whereas no relevant difference was observed in males, indicating that the gender difference on efficacy was larger in nr-axSpA patients.