Do anti-psoriatic drugs work better in women than men?

Linked Article: Maul et al. Br J Dermatol 2021; 185:1160-1168. Psoriasis is a chronic, scaly skin condition affecting about 2·5% of the population. It has a negative impact on people's quality of life, more so in women. It is usually treated with creams but is sometimes severe enough to need strong medicines, which are not always effective. This study examines differences between men and women in their responses to treatment. The 5346 adult patients were identified from Swiss and German patient registries; 60% were male. The men were heavier than women (average 91 kg versus 78 kg). At the start of treatment men had worse psoriasis whereas women had worse quality of life scores. All received systemic medicines, including non-biologics (methotrexate, fumaric acid esters, ciclosporin, acitretin or apremilast) or biologics (adalimumab, etanercept, infliximab, ustekinumab or secukinumab). They were followed up for up to a year after starting treatment and women showed better improvements on two scales called the Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) than men. These results might reflect better drug adherence in women, or their lower bodyweight - where the same dose is used for men and women, women will receive a higher dose per kilogram of body tissue. Also, because of hormonal factors, women's bodies contain a higher proportion of fat, which may allow the drug to spread more easily through the body. Finally, women experience their psoriasis more negatively than men and so there was more room for improvement in DLQI. These findings indicate a need for more personalized treatment, taking gender into account.