TNF blockers
Using the example of axSpA, Dr. Späthling-Mestekemper also showed that men and women respond differently to tumor necrosis factor (TNF) blocker therapy. “The duration of therapy with TNF blockers is shorter for women: 33.4 months versus 44.9 months. They respond less to this therapy; they stop and change more frequently.”
Data from March 2023 show that, in contrast, there is no evidence of a difference in response to Janus kinase inhibitor treatment.
The presence of enthesitis has been discussed as one reason for the worse response to TNF blockers in women, since they have it more often than men do. “In fact, a better response to TNF blockers is associated with HLA-B27 positivity, with the absence of enthesitis and with TNF blocker naivety. In women, higher fat-mass index could also play a part, or even abdominal weight gain, which also increases in women after menopause,” said Dr. Späthling-Mestekemper.
She mentioned the following other potential reasons for a delayed therapy response to biological drugs in women:
- Genetic, physical, or hormonal causes
- Widespread pain or fibromyalgia
- Late diagnosis or late application of therapy, which lowers the chances of remission.
Even the science itself has shown the following sex-specific shortcomings:
- Disregarding sex-specific differences in animal-experimental studies (which, until recently, were only conducted in male mice to avoid hormone fluctuations)
- Women in clinical studies are still underrepresented: only 37% of the populations in phase 3 studies are women; 64% of studies do not describe any sex-specific differences
- Most of the data come from epidemiological analyses (not from basic research)
- Gaps in medical textbooks
Communication differences
Female patients are looking for explanations, whereas male patients describe specific symptoms. Female physicians talk, while male physicians treat. They sound like stereotypes, but they have been substantiated in multiple studies, said Dr. Späthling-Mestekemper. In general, the study results show that male patients behave in the following ways:
- Describe their symptoms in terms of specifics
- Do not like to admit having mental health issues
- Are three to five times more likely to commit suicide because of depression than women
On the other hand, female patients behave in the following ways:
- Look for an explanation for their symptoms
- Often do not have their physical symptoms taken seriously
- Are often pushed in a psychosomatic direction.
Female physicians focus on the following questions:
- Prevention, communication, shared decision-making, open-ended questions, “positive” discussions, patient self-management (chronic diseases such as diabetes: female physicians are better at reaching the therapy goals set by the ADA guidelines than male physicians)
- Psychosocial situations: consultations last 1 minute longer (10%).
Male physicians focus on the following questions:
- Medical history
- Physical examination (cardiac catheterizations after a heart attack are arranged much more commonly by male rather than female physicians)
- Diagnostics