BackgroundSex differences in phenotype presentation, disease trajectory and treatment response in psoriatic arthritis (PsA) have been reported. Nevertheless, whether classes of targeted therapies differentially affect men and women with PsA remains unclear.ObjectivesTo assess the effect of sex on the long-term persistence of each class of targeted therapies in PsA.MethodsThis nationwide cohort study involved the administrative healthcare database of the French health insurance scheme linked to the hospital discharge database. We included all adults with PsA who were new users of targeted therapies (not in the year before the index date) during 2015–2021 and studied all treatment lines during the study period. Persistence was defined as the time from treatment initiation to discontinuation and was estimated by the Kaplan-Meier method. Comparison of persistence by sex involved multivariate frailty models with conventional synthetic disease-modifying antirheumatic drugs and prednisone as time-dependant variables.ResultsWe included 14 778 patients with PsA who were new users of targeted therapies: 8475 (57%) women (mean age 50±13 years; 15 831 lines), 6303 (43%) men (mean age 51±13 years; 10 488 lines). Overall, 1-year persistence was 52% for women and 62% for men and at 3 years it was 27% and 39%, respectively. After adjustments, persistence was lower for women than men for inhibitors of tumour necrosis factor (TNFi) (adjusted HR (HR_a) 1.4, 99% CI 1.3 to 1.5) and interleukin 17 inhibitor (IL17i) (HR_a1.2, 99% CI 1.1 to 1.3) but not IL12/23i (HR_a1.1, 99% CI 0.9 to 1.3), IL23i (HR_a1.1, 99% CI 0.7 to 1.5) or Janus kinase inhibitor (JAKi) (HR_a1.2, 99% CI 0.9 to 1.6).ConclusionThe treatment persistence was lower for women than men for TNFi and IL17i but not for IL12/23i, IL23i or JAKi.