Menopausal Status and Disease Outcomes in Women With Rheumatoid Arthritis Receiving Anti-tumor Necrosis Factor (TNF) and Anti-IL-6 Therapies

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease in which biologic therapies target remission or low disease activity. Sex hormones, particularly estrogens, influence immune responses, and hormonal changes across life stages may impact RA course and therapeutic outcomes. This study aimed to compare remission between menopausal and non-menopausal women with RA, assess time to first remission, and identify predictors of sustained remission. Methods: A retrospective longitudinal study was conducted at the Rheumatology Department A of Ibn Sina Hospital Center, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat-Salé, Morocco, including RA patients aged ≥18 years, treated with anti-TNF (tumor necrosis factor) or anti-IL-6 (interleukin-6) for ≥6 months, as monotherapy or combined with csDMARDS. Menopausal status was defined according to the World Health Organization (WHO) criteria. Patients were classified into menopausal (M-Gr) and non-menopausal (NM-Gr) groups. DAS28 and SDAI assessed disease activity. Remission was defined as DAS28-CRP ≤2.6 and sustained remission as ≥6 months. Results: Seventy-five patients were included: 49 (65.3%) in the menopausal group and 26 (34.7%) in the non-menopausal group. The mean age was 55 ± 13 years, and the mean disease duration was 15 ± 8 years. Anti-TNFα therapy was used in 55 (73.3%) patients and anti-IL-6 therapy in 20 (26.7%) patients. In addition, 50 (66.7%) patients had prior exposure to bDMARDs. Remission was achieved in 25 (51.1%) patients in the M-Gr and 12 (46.2%) in the NM-Gr (p = 0.68). The median time to first remission was 12 weeks in the M-Gr compared with 14 weeks in the NM-Gr, with no statistically significant difference (p = 0.08). Sustained remission was observed in 23 (46.9%) patients in the M-Gr and eight (30.7%) in the NM-Gr (p = 0.17). Higher baseline swollen joint count (OR = 0.28, p = 0.02) and higher baseline tender joint count (OR = 0.35, p = 0.03) were independently associated with lower odds of sustained remission. Furthermore, Menopausal status was not independently associated with sustained remission (OR = 0.19, p = 0.43). Discussion: Our study indicates that menopausal status does not significantly influence remission rates in women with RA receiving anti-TNF or anti-IL6 therapy. These findings suggest that biologic treatments may overcome hormonal-related differences in inflammatory activity. Conclusion: Menopausal status was not significantly associated with remission outcomes in RA patients treated with biologic therapy.