Abstract | OBJECTIVES: To investigate the association between tobacco smoking and disease activity, treatment adherence and treatment responses among patients with psoriatic arthritis (PsA) initiating the first tumour necrosis factor α inhibitor therapy (TNFi) in routine care. METHODS: Observational cohort study based on the Danish nationwide DANBIO registry. Kaplan-Meier plots, logistic and Cox regression analyses by smoking status (current/previous/never smoker) were calculated for treatment adherence, ACR20/50/70-responses and EULAR-good-response. Additional stratified analyses were performed according to gender and TNFi-subtype ( adalimumab/ etanercept/ infliximab). RESULTS: Among 1388 PsA patients included in the study, 1148 (83%) had known smoking status (33% current, 41% never and 26% previous smokers). Median follow-up time was 1.22 years (IQR 0.44-2.96). At baseline, current smokers had lower Body Mass Index (27 kg/m(2) (23-30)/28 kg/m(2) (24-31)) (median (IQR)), shorter disease duration (3 years (1-8)/5 years (2-10)), lower swollen joint count (2 (0-5)/3 (1-6)), higher visual-analogue-scale (VAS) patient global (72 mm (54-87)/68 mm (50-80)), VAS fatigue (72 mm (51-86)/63 mm (40-77)) and Health Assessment Questionnaire ( HAQ) score (1.1 (0.7 to 1.5)/1.0 (0.5 to 1.5)) than never smokers (all p<0.05). Current smokers had shorter treatment adherence than never smokers (1.56 years (0.97 to 2.15)/2.43 years (1.88 to 2.97), (median (95% CI)), log rank p=0.02) and poorer 6 months' EULAR-good-response rates (23%/34%), ACR20 (24%/33%) and ACR50 response rates (17%/24%) (all p<0.05), most pronounced in men. In current smokers, the treatment adherence was poorer for infliximab (HR) 1.62, 95% CI 1.06 to 2.48) and etanercept (HR 1.74, 1.14 to 2.66) compared to never smokers, but not for adalimumab (HR 0.80, 0.52 to 1.23). CONCLUSION: In PsA, smokers had worse baseline patient-reported outcomes, shorter treatment adherence and poorer response to TNFi's compared to non-smokers. This was most pronounced in men and in patients treated with infliximab or etanercept.
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Authors | Pil Højgaard, Bente Glintborg, Merete Lund Hetland, Torben Højland Hansen, Philip Rask Lage-Hansen, Martin H Petersen, Mette Holland-Fischer, Christine Nilsson, Anne Gitte Loft, Bjarne Nesgaard Andersen, Thomas Adelsten, Jørgen Jensen, Emina Omerovic, Regitse Christensen, Ulrik Tarp, René Østgård, Lene Dreyer |
Journal | Annals of the rheumatic diseases
(Ann Rheum Dis)
Vol. 74
Issue 12
Pg. 2130-6
(Dec 2015)
ISSN: 1468-2060 [Electronic] England |
PMID | 25063827
(Publication Type: Journal Article, Observational Study)
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Copyright | Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ |
Chemical References |
- Antirheumatic Agents
- Receptors, Tumor Necrosis Factor
- Infliximab
- Etanercept
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Topics |
- Adult
- Antirheumatic Agents
(therapeutic use)
- Arthritis, Psoriatic
(drug therapy, metabolism)
- Etanercept
(therapeutic use)
- Female
- Follow-Up Studies
- Humans
- Infliximab
(therapeutic use)
- Male
- Middle Aged
- Receptors, Tumor Necrosis Factor
(antagonists & inhibitors)
- Registries
- Retrospective Studies
- Smoking
(adverse effects)
- Treatment Outcome
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