Cigarette Smoking Does Not Affect Treatment Response to Tofacitinib in Rheumatoid Arthritis

Ahmet Karatas¹, Burak Oz², Ediz Dalkiliç³, Gerçek Can⁴, Yavuz Pehlivan⁵, Soner Senel⁶, Ayten Yazici⁷, Nevsun Inanc⁸, Zeynep Erturk⁹, Ayse Cefle⁷, Servet Akar¹⁰, Suleyman Serdar Koca¹¹, Merih Birlik⁴ and Fatos Onen⁴, ¹Department of Rheumatology, Firat University, School of Medicine, Rheumatology, Elazig, Turkey, ²Rheumatology, Firat University, School of Medicine, Rheumatology, Elazig, Turkey, ³Rheumatology, Uludag University Faculty of Medicine, Bursa, Turkey, ⁴Rheumatology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey, ⁵Rheumatology, Uludag University, Faculty of Medicine, Bursa, Turkey, ⁶Rheumatology, Kayseri Erciyes University, Faculty of Medicine, Kayseri, Turkey, ⁷Rheumatology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey, ⁸Department of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey, ⁹Department of Internal Medicine, Division of Rheumatology, Marmara University, Istanbul, Turkey, ¹⁰Department of Internal Medicine, Division of Rheumatology,, Izmir Katip Çelebi University Faculty of Medicine, Izmir, Turkey, ¹¹Rheumatology, Firat University Faculty of Medicine, Elazığ, Turkey

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Rheumatoid arthritis (RA), tobacco use, tofacitinib and tofacitinib

Session Information

Date: Monday, October 22, 2018

Title: Rheumatoid Arthritis – Treatments Poster II: PROs, Safety and Comorbidity

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Smoking is one of the described risk factors for rheumatoid arthritis (RA) since smoking may induce citrullination of peptide antigens and thus the trigger anti-citrulline immunity. Moreover, smoking increases the disease activity and radiological progression in RA. Current smoking is associated with poor responses to therapy with anti-rheumatic drugs including methotrexate and anti-TNF agents in RA. The aim of our study was to investigate whether cigarette smoking influences the response to tofacitinib treatment in patients with RA.

Methods: Data on patient characteristics patients receiving targeted treatments have been collected since 2011 in Turkish Biologic (TURKBIO) Registry. By the end of May 2018, 115 RA patients received tofacitinib from the TURKBIO registry, were included in the analysis. Patients were divided into subgroups as current smokers and non-smokers (never+ex-smokers). Demographic and clinical data including age, sex, disease type, disease duration, and previous or current treatment with disease-modifying anti-rheumatic drugs and tofacitinib usage durations are compared. Kaplan-Meier survival analysis was performed to estimate the drug survival of tofacitinib.

Results: There were no significant differences in gender, seropositivity, tender and swollen joint counts at baseline in the study groups, although current smokers were significantly younger (p<0.001). Almost all baseline parameters were similar in the current smokers and non-smokers. 71.6% and 65.1% of current smokers and 68.2% and 48.6% of non-smokers were going on the treatment at 6^th and 12^th months, respectively (p=0.378). There was no significant difference between groups in terms of drug survival rates for tofacitinib.

Table 1. Clinical and laboratory characteristics

	Current Smokers (n=27)	Non-Smokers (n=88)	p
Age, year	44.5 (35.8-53)	56.5 (47.6-63)	<0.001
Gender (Females), n (%)	20 (74.1)	77 (87.5)	0.128
Disease duration, years	10 (4-16)	10.5 (5-16.5)	0.835
Tofacitinib is 1^st choice biologic or targeted DMARD, %	48.1	56.8	0.509
Concomitant glucocorticoid usage, %	41.1	51.1	0.346
Glucocorticoid dosage, mg/day	4 (4-5)	5 (4-6)	0.173
RF positivity, n (%)	77.8	65.6	0.328
CCP positivity, n (%)	25.1	28.8	0.763
Baseline swollen joint count, n	2 (0-4)	3 (0-5)	0.521
Baseline tender joint count, n	3.5 (2-7)	5 (2-9)	0.371
Baseline ESR, mm/h	24 (19-38)	36 (17-55)	0.099
12^th month ESR, mm/h	16 (12-31)	28 (21-52)	0.063
Baseline CRP, mg/dl	4 (3-8)	5.4 (3.33-15.45)	0.232
12^th month CRP, mg/dl	3 (1-6)	8 (3.02-11)	0.139
Baseline DAS28-CRP	4 (3-4.8)	4.4 (3.5-4.9)	0.279
12^th month DAS28-CRP	1.7 (1.3-3)	2.1 (1.9-3.1)	0.233
Baseline HAQ	1 (0.625-1.5)	1 (0.75-1.5)	0.849
12^th month HAQ	0 (0-0.25)	0.75 (0.25-1.375)	0.020

DMARD; disease modifying anti-rheumatic drug, RF; rheumatoid arthritis, CCP; cyclic citrulinated peptide, ESR; erythrocyte sedimentation rate, CRP; C-reactive protein, DAS; disease activity score, HAQ; Health Assessment Questionnaire.

Conclusion: Current smoking does not affect the response and drug survival for tofacitinib in RA. However, it is obvious that smoking is related with high morbidity and mortality in RA, since it increases pulmonary disabilities and the risks of atherosclerosis and malignancies. Moreover, it is known to increase the risk for RA, and the clinical and radiological progression of RA. Therefore, the cessation of tobacco use should be still advised to all smoker RA patients.

Disclosure: A. Karatas, None; B. Oz, None; E. Dalkiliç, None; G. Can, None; Y. Pehlivan, None; S. Senel, None; A. Yazici, None; N. Inanc, None; Z. Erturk, None; A. Cefle, None; S. Akar, None; S. S. Koca, None; M. Birlik, None; F. Onen, None.

To cite this abstract in AMA style:

Karatas A, Oz B, Dalkiliç E, Can G, Pehlivan Y, Senel S, Yazici A, Inanc N, Erturk Z, Cefle A, Akar S, Koca SS, Birlik M, Onen F. Cigarette Smoking Does Not Affect Treatment Response to Tofacitinib in Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/cigarette-smoking-does-not-affect-treatment-response-to-tofacitinib-in-rheumatoid-arthritis/. Accessed .

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