Impact of tobacco smoking on response to tumour necrosis factor-alpha inhibitor treatment in patients with ankylosing spondylitis: results from the Danish nationwide DANBIO registry

• Published in: Rheumatology (Oxford, England) Vol. 55; no. 4; pp. 659 - 668
• Main Authors: Glintborg, Bente, Højgaard, Pil, Lund Hetland, Merete, Steen Krogh, Niels, Kollerup, Gina, Jensen, Jørgen, Chrysidis, Stavros, Jensen Hansen, Inger Marie, Holland-Fischer, Mette, Højland Hansen, Torben, Nilsson, Christine, Espesen, Jakob, Nordin, Henrik, Rasmussen Loft, Anne Gitte, Pelck, Randi, Lorenzen, Tove, Flejsborg Oeftiger, Sussi, Unger, Barbara, Jaeger, Frank, Mosborg Petersen, Peter, Rasmussen, Claus, Dreyer, Lene
• Format: Journal Article
• Language: English
• Published: England 01.04.2016
• Subjects: Adult; Antirheumatic Agents - therapeutic use; Denmark - epidemiology; Female; Humans; Kaplan-Meier Estimate; Male; Medication Adherence - statistics & numerical data; Middle Aged; Registries; Smoking - adverse effects; Smoking - epidemiology; Spondylitis, Ankylosing - drug therapy; Spondylitis, Ankylosing - epidemiology; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Denmark; Routine care; Outcome; Ankylosing spondylitis; Tumour necrosis factor-alpha inhibitors; Smoking
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/kev392

To investigate the association between tobacco smoking and disease activity, treatment adherence and treatment responses in patients with AS treated with their first tumour necrosis factor-alpha inhibitor (TNFi) therapy in routine care. Observational cohort study based on the Danish nationwide DANBIO registry. Kaplan-Meier plots, Cox and logistic regression analyses by smoking status (current/never/previous) were calculated for treatment adherence and BASDAI 50%/20 mm-response. Additional stratified analyses were performed for gender and TNFi-type. Of 1576 AS patients included in the study, 1425(90%) had known smoking status (current/never/previous: 43%/41%/16%). The median follow-up time was 2.02 years (IQR 0.69-5.01). At baseline, current smokers compared with never smokers had longer disease duration (4 years (1-12)/2 years (0-10)), higher BASDAI (61 mm (47-73)/58 mm (44-70)), BASFI (53 mm (35-69)/46 mm (31-66)) and BASMI (40 mm (20-60)/30 mm (10-50)) scores (all P < 0.01). Current and previous smokers had shorter treatment adherence than never smokers (current: 2.30 years (1.81-2.79) (median (95% CI)); previous: 2.48 years (1.56-3.40), never: 4.12 years (3.29-4.95)), P < 0.0001). Similar results were found in multivariate analyses (current versus never smokers, HR 1.41 (95% CI 1.21-1.65), P < 0.001), most pronounced among men. Current smokers had poorer 6 months' BASDAI50%/20 mm-response rate than never smokers (42%/58%, P < 0.001). In multivariate analyses, current smokers had lower odds of achieving BASDAI50%/20 mm-response than never smokers, both overall (OR 0.48 (95% CI 0.35-0.65), P < 0.0001) and for the different TNFi-types (adalimumab 0.45 (0.27-0.76)/etanercept 0.24 (0.10-0.61)/infliximab 0.57 (0.34-0.95)). In this study of TNFi-treated AS patients in clinical practice, current and previous smokers had significantly poorer patient-reported outcomes at baseline, shorter treatment adherence and poorer treatment response compared with never smokers.