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Creating a New Body of Evidence
Gender Differences in Treatment Response in Early versus Established Rheumatoid Arthritis

January, 2012 - In a recent publication in the Journal of Rheumatology, CHORI Assistant Scientist Damini Jawaheer, PhD, and her Danish colleagues utilized a national rheumatoid arthritis (RA) registry in Denmark to conduct a study that compared for the first time gender differences in response to therapy in early versus established RA. The results indicated that men who had early RA responded much better to treatment than women who had early RA, but that the responses between men and women who had established RA were similar and without as significant benefit.

"What we found is that the earlier the male patients were given therapy after diagnosis, the better they responded," says Dr. Jawaheer. "We still need to do further work to understand why women respond so differently."

“The earlier the male patients were given therapy after diagnosis, the better they responded.”



RA is predominantly a disease afflicting women, with three times more women than men suffering from RA. Yet differences in RA symptoms, progression, and response to treatment between men and women are only just being explored.

"In the clinic, men and women with rheumatoid arthritis are treated the same, and the general notion seems to be that women complain more, but that they are not actually worse off," says Dr. Jawaheer. "However, in a previous study of treatment responses to non-biologic therapies, we found that progression of RA to its more severe forms was worse among women, although men and women were on similar treatment. Differences like these are only just beginning to be addressed."

The current publication built on the previous one by examining gender differences in response to biologic anti-TNF therapy, and how time since RA diagnosis influences these differences, by comparing the treatment responses in patients who had had RA for two years or less with patients who had had RA for more than two years.

"Biologic medications like the anti-TNF are relatively new on the market. It makes sense to find out which patients have good responses to the drugs, given how expensive they are," says Dr. Jawaheer. "You want to know you are getting the most benefit from the treatment."

What the study demonstrated most dramatically, however, was that there was a better outcome for men when they received anti-TNF therapy less than two years after being diagnosed; this was not seen among the women.

"What exactly is happening and why we are seeing these differences isn't clear, it's likely that if a patient has had RA for more than two years, the disease may have had some irreversible progression," says Dr. Jawaheer.

“There is clearly so much more work to be done in this field. Our results suggest that maybe we need to start thinking differently and explore whether there is a need to use different treatment approaches for women than for men in RA.”

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Thursday, May 17, 2012 12:50 PM

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