195 Lubrano, et al: Sex influence in axSpA Personal non-commercial use only. The Journal of Rheumatology Copyright © 2018. All rights reserved. The Sex Influence on Response to Tumor Necrosis Factor-α Inhibitors and Remission in Axial Spondyloarthritis Ennio Lubrano, Fabio Massimo Perrotta, Maria Manara, Salvatore D’Angelo, Olga Addimanda, Roberta Ramonda, Leonardo Punzi, Ignazio Olivieri, Carlo Salvarani, and Antonio Marchesoni ABSTRACT. Objective. The aim of this study was to evaluate the influence of sex on response to treatment and disease remission in patients with axial spondyloarthritis (axSpA). Methods. In this retrospective multicenter study, patients with axSpA, according to the Assessment of Spondyloarthritis international Society (ASAS) criteria for axSpA, and treated with adalimumab, etanercept, golimumab, or infliximab, were studied. We compared clinical characteristics, patient-reported outcomes, disease activity, function, and response to treatment in male and female patients with this disease. Results. Three hundred forty patients with axSpA (270 with ankylosing spondylitis, 19 with psoriatic arthritis with axial involvement, and 51 with nonradiographic axSpA) were studied. Male subjects had a significantly higher prevalence of grade IV sacroiliitis, higher levels of serum C-reactive protein, lower Maastricht Ankylosing Spondylitis Enthesitis Score, and fatigue when compared with females. Further, Kaplan-Meier survival curves showed that the rate of partial remission, ASAS40 response, and Ankylosing Spondylitis Disease Activity Score (ASDAS) major improvement, but not ASDAS inactive disease, were significantly lower in female patients. Conclusion. Our data suggest that female sex was associated with a lower rate of response to treatment and of disease remission in patients with axSpA treated with antitumor necrosis factor-α drugs. (First Release November 15 2017; J Rheumatol 2018;45:195–201; doi:10.3899/jrheum.170666) Key Indexing Terms: SPONDYLOARTHRITIS REMISSION RESPONSE TO TREATMENT ANTITUMOR NECROSIS FACTOR-α DRUGS From the Dipartimento di Medicina e Scienze della Salute “Vincenzo Tiberio,” Università degli Studi del Molise, Campobasso; Day Hospital of Rheumatology, Azienda Sistema Socio Sanitario (ASST) Centro Specialistico Ortopedico Traumatologico G. Pini-Centro Specialistico Traumatologico-Ortopedico (CTO), Milan; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; La Struttura Semplice Dipartimentale (SSD) di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna, Bologna; Rheumatology Unit, Department of Clinical and Experimental Medicine (DIMED), University of Padua, Padua; Rheumatology Unit, Azienda Ospedaliera-Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia and Università di Modena e Reggio Emilia, Reggio Emilia, Italy. Supported by the Gruppo di Studio Spondiloartriti e Artropatia Psoriasica — Antonio Spadaro. All authors are members of this group. E. Lubrano, MD, PhD, Dipartimento di Medicina e Scienze della Salute “Vincenzo Tiberio,” Università degli Studi del Molise; F.M. Perrotta, MD, Dipartimento di Medicina e Scienze della Salute “Vincenzo Tiberio,” Università degli Studi del Molise; M. Manara, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO; S. D’Angelo, MD, PhD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; O. Addimanda, MD, PhD, SSD di Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Università di Bologna; R. Ramonda, MD, PhD, Rheumatology Unit, DIMED, University of Padua; L. Punzi, MD, PhD, Rheumatology Unit, DIMED, University of Padua; I. Olivieri, MD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera; C. Salvarani, MD, IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia; A. Marchesoni, MD, PhD, Day Hospital of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico G. Pini-CTO. Dr. Ignazio Olivieri died July 28, 2017. Address correspondence to Dr. E. Lubrano, Dipartimento di Medicina e di Scienze della Salute “Vincenzo Tiberio,” Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100 Campobasso, Italy. E-mail: enniolubrano@hotmail.com Accepted for publication September 12, 2017. Spondyloarthritis (SpA) includes a group of chronic inflam- matory diseases that affect both the axial and peripheral skeleton. The Assessment of SpondyloArthritis international Society (ASAS) validated classification criteria for axial SpA (axSpA) 1 include both nonradiographic axSpA (nr-axSpA) and radiographic axSpA or ankylosing spondylitis (AS). Patients with nr-axSpA and AS have comparable, but not identical clinical manifestations and burden of disease: studies show 2 that patients with nr-axSpA have lower presence of magnetic resonance imaging (MRI) lesions, lower prevalence of HLA-B27, and lower levels of C-reactive protein (CRP) compared to patients with AS. Moreover, prevalence of female sex seems to be higher in patients with nr-axSpA. Therefore, some authors argue that nr-axSpA could configure not only the preradiographic stage of AS, but a different disease even within the same umbrella of SpA 2 .