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Smoking may interfere with anti-TNF treatment of axial spondyloarthritis
Patients with axial spondyloarthritis who were active smokers showed poorer response to treatment with anti-tumor necrosis factor inhibitors.
Researchers involved in the Swiss Clinical Quality Management Cohort for Axial Spondyloarthritis (SCQM for axSpA) studied 490 patients diagnosed with axSpA or ankylosing spondylitis who completed follow-up between January 2005 and January 2014. Of the patients studied, 38.4% were current smokers, 23.9% were past smokers and 37.7% had never smoked. None were being treated with anti-tumor necrosis factor (TNF) inhibitors at baseline.
The study’s response outcomes were based on 50% improvement in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI 50) and major improvement in the Ankylosing Spondylitis Disease Activity Score (ASDAS 50) and 40% improvement in the Assessment of SpondyloArthritis International Society (ASAS 40) criteria.
In addition to smoking status, covariate factors with the potential to affect treatment response, such as age, sex, disease duration, HLA-B27 status, BMI and other factors such as C-reactive protein (CRP) levels were analyzed with a variety of statistical methods and models.
After initiating anti-TNF treatment, differences in BASDAI 50 response rates between smokers and nonsmokers ranged from 8% to 21% depending on the adjusted model. Past smoking did not significantly affect any models; however, patients who were active smokers with elevated CRP at baseline had significantly worse BASDAI outcomes, and normalization of CRP levels was less likely to occur in patients who smoked, according to the researchers.
Overall, the researchers found patients who were current smokers had significantly lower odds of achieving BASDAI 50 or ASAS 40 after 1 year than patients who were not smokers. – by Shirley Pulawski
Disclosure: Ciurea has received consulting and/or speaking fees from Abbvie, Merck Sharp and Dohme, Pfizer, UCB, Celgene, Jannsen-Cilag. Please see the full study for a list of all other authors’ relevant financial disclosures.