Prescription Patterns in Psoriatic Arthritis: Insights from a Sex-Based Perspective

Introduction: Emerging evidence suggests sex-related differences in disease presentation, response to therapy, and treatment patterns in psoriatic arthritis (PsA). This study aimed to assess sex-related differences in PsA management, focusing on the use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biologic DMARDs (bDMARDs), and phosphodiesterase-4 (PDE4) inhibitors, as well as the frequency and factors associated with treatment switches and swaps. Methods: We conducted a cross-sectional analysis of two longitudinal PsA cohorts, collecting comprehensive clinical, laboratory, and patient-reported data. Treatment patterns, including the number and type of therapies administered over time and treatment modifications, were evaluated in male and female patients. Univariate analyses identified clinical factors associated with treatment switches and swaps. Results: During the enrollment period, 272 patients with PsA (141 male patients, 131 female patients) were evaluated. Overall, 128 patients (47.1%) received at least one csDMARD, yet only 49 (18%) were managed exclusively with csDMARDs, while 223 (82%) were treated with bDMARDs or PDE4 inhibitors. Male patients were more likely to be treated with csDMARDs monotherapy (22.7% vs. 12.9%, p = 0.03), whereas female patients more frequently received bDMARDs, particularly tumor necrosis factor inhibitors (72.55% vs. 53.2%, p = 0.001). Moreover, female patients received a greater number of bDMARDs (1.1 ± 1.1 vs. 1.5 ± 1.3), and experienced more treatment switches (40.4% vs. 25.7%, p = 0.02) than male patients. Obesity and cardiometabolic comorbidities were associated with therapy switching in male patients, whereas fibromyalgia and anxiety-depression were significant factors in female patients. Conclusions: Our findings highlight significant sex-based differences in PsA management, with female patients requiring more adaptive therapeutic strategies despite similar pharmacological approaches to male patients. Future studies should explore sex-specific variations in disease biology and treatment response to optimize care