We aimed to investigate whether there are sex differences in disease activity measures among patients with axial spondyloarthritis (axSpA) and to determine any potential impact on the assessment of treatment responses to tumor necrosis factor alpha inhibitors (TNFi). Using the Korean College of Rheumatology Biologics and Targeted Therapy (KOBIO) registry data, we compared sex differences in changes in the Bath Ankylosing Spondylitis Disease Activity Score (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) levels at baseline and one year after TNFi initiation in patients with axSpA. This study included 1,753 patients with axSpA who started or changed TNFi, of whom 1,343 (76.6%) were male. At baseline, the mean BASDAI and ASDAS scores of all patients were 5.98 and 3.6, respectively. The BASDAI changes between baseline and the one-year follow-up were independently associated with sex (�� = 0.343, p = 0.011), whereas ASDAS was not (�� = 0.079, p = 0.235). When judging the effect of TNFi at one-year of treatment, male patients were more likely to be assessed as effective by the BASDAI-based criterion (ΔBASDAI ≥ 50% or ≥ 2; OR 1.700, 95% CI 1.200–2.406), while the ASDAS-based criterion (ΔASDAS ≥ 1.1) showed no significant difference between sexes (OR 0.993, 95% CI 0.678–1.455), after adjusting for other baseline characteristics. The changes in disease activity before and after TNFi use were significantly different between sexes when measured by BASDAI, but not ASDAS. TNFi treatment effects may be interpreted differently between sexes depending on the disease activity measure used.

中文翻译：

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中轴型脊柱关节炎患者疾病活动评分的性别差异及其对评估肿瘤坏死因子α抑制剂治疗反应的影响

我们的目的是调查中轴型脊柱关节炎 (axSpA) 患者的疾病活动指标是否存在性别差异，并确定对肿瘤坏死因子 α 抑制剂 (TNFi) 治疗反应评估的潜在影响。使用韩国风湿病生物制品和靶向治疗学院 (KOBIO) 注册数据，我们比较了基线时和 TNFi 治疗一年后巴斯强直性脊柱炎疾病活动评分 (BASDAI) 和强直性脊柱炎疾病活动评分 (ASDAS) 水平变化的性别差异axSpA 患者开始使用。这项研究纳入了 1,753 名开始或改变 TNFi 的 axSpA 患者，其中 1,343 名 (76.6%) 为男性。基线时，所有患者的平均 BASDAI 和 ASDAS 评分分别为 5.98 和 3.6。基线和一年随访期间的 BASDAI 变化与性别独立相关 (�� = 0.343，p = 0.011)，而 ASDAS 则不然 (�� = 0.079，p = 0.235)。在判断 TNFi 治疗一年的效果时，男性患者更有可能根据基于 BASDAI 的标准评估为有效（ΔBASDAI ≥ 50% 或 ≥ 2；OR 1.700，95% CI 1.200–2.406），而在调整其他基线特征后，基于 ASDAS 的标准（ΔASDAS ≥ 1.1）显示性别之间没有显着差异（OR 0.993，95% CI 0.678–1.455）。通过 BASDAI 测量，使用 TNFi 之前和之后疾病活动度的变化在性别之间存在显着差异，但 ASDAS 则没有。根据所使用的疾病活动度测量，TNFi 治疗效果在性别之间可能有不同的解释。