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Abstract：
Background: There is evidence suggesting the existence of sex differences in the effectiveness of specific drug classes for rheumatoid arthritis (RA). Our study stands as the first to elucidate sex-related differences in the effectiveness of Janus kinase (JAK) inhibitors. Methods: The study involved 150 RA patients treated with tofacitinib, baricitinib, upadacitinib, or filgotinib between September 2017 and October 2023. Sex differences in achieving remission and low disease activity (LDA) were identified through logistic regression analyses. Sex disparities in treatment effectiveness survival were evaluated through the Kaplan-Meier estimate, employing the log-rank test for comparison. The Cox model was applied to analyze the variable sex as a potential factor that could influence the maintenance of the JAK inhibitor treatment effectiveness. Results: Concerning the achievement of remission and LDA, no differences were observed between sexes in terms of the 28-joint Disease Activity Score (DAS28) C-reactive protein (CRP), the Clinical Disease Activity Index (CDAI), and the Simplified Disease Activity Index (SDAI). With respect to the DAS28-erythrocyte sedimentation rate (ESR), female patients, compared to males, possessed 70% lower odds of achieving remission (p = 0.018) and 66% lower odds of achieving LDA (p = 0.023). No differences were observed in treatment effectiveness survival between sexes (p = 0.703). Sex was not found to influence the survival of JAK inhibitor treatment effectiveness (p = 0.704). Conclusions: Being a female or male patient does not entail differences in the effectiveness of the JAK inhibitor treatment. Our findings encourage the consideration of a global pool of composite indices (DAS28-ESR/CRP, CDAI, SDAI) to measure RA disease activity, thus individualizing the target value as advocated by the treat-to-target strategy.
摘要：
背景：有证据表明，类风湿关节炎（RA）的特定药物类别的有效性存在性别差异。我们的研究首次阐明了Janus激酶（JAK）抑制剂的有效性与性别相关的差异。方法：该研究涉及150例接受托法替尼治疗的RA患者，baricitinib,upadacitinib,或在2017年9月至2023年10月之间的filgotinib。通过逻辑回归分析确定了实现缓解和低疾病活动（LDA）的性别差异。通过Kaplan-Meier估计评估治疗效果生存率的性别差异，采用对数秩检验进行比较。Cox模型用于分析可变性别作为可能影响JAK抑制剂治疗有效性维持的潜在因素。结果：关于缓解和LDA的实现，在28关节疾病活动评分（DAS28）C反应蛋白（CRP）方面，性别之间没有观察到差异，临床疾病活动指数(CDAI)，和简化疾病活动指数(SDAI)。关于DAS28-红细胞沉降率（ESR），女性患者,与男性相比，达到缓解的几率降低70%(p=0.018)，达到LDA的几率降低66%(p=0.023)。性别之间的治疗效果生存率没有差异（p=0.703）。性别未发现影响JAK抑制剂治疗有效性的存活(p=0.704)。结论:作为女性或男性患者,JAK抑制剂治疗的有效性不存在差异。我们的发现鼓励考虑全球综合指数库(DAS28-ESR/CRP，CDAI,SDAI)用于测量RA疾病活动，从而将目标价值个性化，正如对待目标战略所倡导的那样。
