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Smoking negatively impacts response to biologics in patients with RA

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Patients with rheumatoid arthritis who smoked showed a poorer response to treatment with biologic agents, particularly tumor necrosis-alpha inhibitors, according to researchers.

Researchers conducted a retrospective study of 145 patients with rheumatoid arthritis (RA) who attended a rheumatology department in a Portuguese university hospital to receive biologic therapy and who had data available on smoking history. Patients were 88.3% women with a mean disease duration of 16.5 years and 82.8% were positive for rheumatoid factor. Demographic information and disease characteristics data were collected.

The median disease activity score in 28 joints (DAS28) was 6.09 and the Health Assessment Questionnaire score was 1.86 at baseline. Thirty-five patients had a history of current or former smoking. Patients who smoked tended to be younger than nonsmokers and were more likely to be men. Biologic agents included Rituxan (rituximab, Genentech), Actemra (tocilizumab, Genetech) and Orencia (abatacept, Bristol-Meyers Squibb).

Follow-up was conducted at 6, 12 and 18 months, and statistical analysis was adjusted for age and sex.

At 6 months, the median reduction in DAS28 was – 1.41 in smokers compared to – 1.68 in nonsmokers and the difference remained before and after adjustment for age but not gender. A smaller number of patients achieved a moderate or good European League Against Rheumatism (EULAR) response among smokers (56.5% vs. 75.3%) at 6 months of follow-up. Similar results were seen at 12 1.79 vs. 1.84) and 18 vs. 2.) months.

Smokers who received tumor necrosis-alpha inhibitors responded more poorly to treatment. At 6 months, DAS28 scores in patients who smoked decreased by 0.75 compared to a reduction of 1.43 in nonsmokers. At 12 months, the score was reduced by 1.63 compared to 2.16 and at month 18, smokers’ DAS28 was reduced by 1.4 compared to 2.3 in nonsmokers. – by Shirley Pulawski

Reference:

Madureira PS, et al. Paper #SAT0130. Presented at: European League Against Rheumatism Annual European Congress of Rheumatology. June 10-13, 2015; Rome.

Disclosure: The researchers report no relevant financial disclosures.