Background/Purpose

Smoking has been reported as associated with increase disease activity, more functional impairment, poorer quality of life and more radiographic damages in patients (pts) with axial spondyloarthritis (SpA). However, there is little information available about a potential effect of smoking on the effectiveness of anti-rheumatic treatment such as TNF blockers. The study objective was to examine the association of smoking with clinical outcome after treatment with TNF blockers in patients with axial SpA.

Methods

A monocenter ambispective observational study in 96 patients with active axial SpA starting a treatment with a first TNF blocker. BASDAI, pain VAS, analgesics and NSAIDs consumption, and variables known as treatment response predictive factors were collected at baseline, 3, 6 and 12 months. The main outcome was the percentage of BASDAI 50 responders at M6. Secondary outcomes were BASDAI variation, pain VAS variation and NSAIDs consumption at M3, M6 and m12. We analyzed disease activity and response to treatment in current smokers vs. non-smokers using a chi-square test or one-way analysis of variance (depending on categorical/continuous variables). SPSS 17.0 version was used for the management and statistical analysis.

Results

Patients’ demographic and clinical characteristics at baseline are shown in table 1. Thirty-five pts (36%) were current smokers (14.6±6.4 cigarettes/day). No  significant differences were observed between current smokers and non-smokers at baseline. Patients were mainly treated with infliximab (84%). The percentage of BASDAI 50 responders at M6 was 34%(12/35) and 39%(24/61), in the smokers and the non-smokers group, respectively (p>0.6). No statically significant differences were observed between current smoker and nonsmokers in BASDAI variation, pain VAS variation or treatment consumption at each evaluation time.

Conclusion

Smoking status seems not to be a predictive factor of response to TNF-blockers in patients with axial SpA.

Smokers Non-smokers p Baseline N = 35 N=61   Gender, male (n, %) 17 (48.6%) 35 (57.4%) 0.52 Age, years, (mean, SD) 44 (14) 44 (9) 0.99 Disease duration, years, (mean, SD) 11.6 (11.1) 12.0 (9.1) 0.84 DMARDs, yes (n, %) 6 (17.1%) 11 (18.0%) 0.91 NSAIDs, yes (n, %) 26 (74.3%) 42 (68.9%) 0.57 BASDAI (0-100), (mean, SD) 6.0 (1.6) 5.4 (1.7) 0.07 Pain EVA (0-10), (mean, SD) 6.3 (2.3) 5.8 (1.9) 0.26 CRP mg/l, (mean, SD) 16.0 (22.0) 10.0 (16.0) 0.09

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/smoking-is-not-associated-with-response-to-tnf-blockers-in-patients-with-axial-spondyloarthritis/