Women Report Greater Psoriasis QOL Impact, Reduced Treatment Satisfaction With Biologics

Despite similar efficacy of biologics observed in the treatment of men and women with psoriasis, female patients reported the disease was associated with a greater impact on quality of life (QOL) and lower treatment satisfaction. Study findings were published in Women’s Health Reports.

In the pathophysiology of psoriasis, several studies have indicated gender differences in various aspects of disease, including clinical characteristics, type of treatment, and outcomes. Notably, a higher impact of psoriasis on QOL and a lower treatment satisfaction have been reported previously in women.

“Considering the impact of sexual variables on diseases can lead to improvements in care, especially in drug therapy, since gender differences in drug pharmacokinetics and tolerability have been identified,” said the study authors.

They conducted a post hoc gender analysis of the CANOVA study (Effectiveness of biologic treatments for plaque psoriasis in Italy: an observational longitudinal study of real-life clinical practice), a multicenter, retroprospective analysis of adult patients with moderate to severe plaque psoriasis treated with biologics in 17 Italian hospital dermatology clinics.

Between April 2018 and February 2019, 669 (92.0%) eligible participants were recruited for the post hoc analysis, in which 427 (63.8%) were males and 242 (36.2%) were females. The primary end point ​​assessed the clinical response rates after 16, 24, and 52 weeks after the initiation of biologic treatment, measured via Psoriasis Area Severity Index 75%, 90%, and 100% response (PASI 75, PASI 90, PASI 100) and a body surface area (BSA) less than or equal to 3% or a BSA improvement of 75% or greater at 16 weeks and afterward as a BSA less than or equal to 1%.

Secondary objectives examined the description of treatment response by gender, measured via Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9 subscale scores) and the Dermatology Life Quality Index (DLQI) questionnaire, and the possible differences between sexes in patients’ treatment satisfaction and QOL. Among the study cohort, demographic and baseline characteristics and duration of disease were indicated to be homogeneous between sexes.

Findings showed that slightly more women had been treated with biologics (50.4% vs 46.5%) and had received 2 or more biologic treatment lines (17.2% vs 12.4%) before study treatment. The most frequently used biologics were secukinumab, ustekinumab, adalimumab, and ixekizumab in both sexes.

At 6 months, PASI 75/90/100 responders were 90.8%/72.3%/45.3% of men and 89.2%/76.6%/48.2% of women, and BSA responders were 81.3% of men and 83.1% of females. Sustained PASI responders were 79.5% of men and 75.9% of women, and sustained BSA responders were 57.7% of men and 51.4% of females.

At enrollment, treatment satisfaction (TSQM-9) was significantly lower in women vs men for all subscales. Treatment satisfaction was still lower at 6 months for women, but this association was no longer significant. Furthermore, gender distribution in DLQI total score classes showed a significantly greater effect of psoriasis on QOL in women, both at enrollment (Fisher’s exact test, P = .0008) and at the 6-month follow-up (P = .0087).

“These differences in the burden of disease perceived by women compared to men suggest once more that optimization of therapy may require gender attention and confirm the need for studies evaluating the gender impact of diseases and treatments,” concluded researchers.

Reference
Colombo D, Bianchi L, Fabbrocini G, et al. The CANOVA study real-world evidence of biologic treatments in moderate-severe psoriasis in Italy: A gender perspective. Womens Health Rep (New Rochelle). 2022 May 2;3(1):450-457. doi:10.1089/whr.2021.0124