Session Information
Date: Tuesday, October 23, 2018
Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster III: Treatment
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
The aim of the study was to investigate the impact of smoking on disease activity, treatment adherence and treatment response in psoriatic arthritis (PsA) patients on tumour necrosis factor-alpha inhibitor (TNFi) therapy in a real-life cohort.
Methods:
PsA patients treated with their first TNFi therapy (including adalimumab, certolizumab, etanercept, golimumab and infliximab) in TURKBIO registry were included in the study. Demographic and clinical features of current smokers were compared with never smokers and previous smokers.
Treatment response was evaluated as achievement of EULAR-good-response (yes/no) at the 3-monthsÕ and 6-monthsÕ visits. We classified patients as ÔrespondersÕ if they achieved clinical response at the both 3-monthsÕ and 6 monthsÕ visits.
DAS28-CRP, CDAI and HAQ measurements and also ESH and serum CRP levels were compared between the study groups at baseline. After 3 months and 6 months, changes in these parameters were measured again and recompared between the groups.
Results:
Among 102 PsA patients analysed (62 % women; mean age: 41.5) in the study, 97 (95%) had known smoking status. The median follow-up time was 1.3 years (IQR: 0.2-2.3) and disease duration was 3 years (0.6-7.7). No significant difference was found in these parameters between current, never and previous smokers.
At baseline, current smokers were younger and had higher methotrexate use rate (p=0.009) compared with previous smokers. Never smokers had female predominance and higher erythrocyte sedimentation rate (ESR) compared with current smokers. Disease duration, body mass index, CRP and baseline disease indexes (DAS28CRP, CDAI, HAQ) were not found to be different between current and never smokers and also previous smokers. Treatment adherence for TNFi showed no difference between the groups (Table 1). The use of concomitant DMARDs was also similar.
Treatment response (EULAR good response) was found to be similar between current, never and previous smokers. The changes in the measurements of DAS28-CRP, CDAI and HAQ at the month 3 and 6 revealed also no difference.
In multivariate analysis, patients with high CRP (OR:2.8; 95% CI (0.91-8.55), p=0.07) and longer biologic follow up time (>1 year) (OR:15.47; 95%CI (5.52-43.35), p<0.01) were found to be associated with EULAR-good responses.
The treatment adherence was better in patients having high ESR (HR:1.87; 95% CI (1.08-3.25), p=0.03) and high clinical disease activity (CDAI>22) (HR:2.5; 95% CI (1.27-5.10), p=0.009). However, smoking status was neither associated with treatment response (EULAR-good response) nor treatment adherence in the patients.
Conclusion:
This study suggested that smoking might not be associated with disease activity, treatment adherence and treatment response in PsA patients treated with TNFi in clinical practice.
Table 1. Baseline demographic and clinical features; and treatment adherence and responses in study groups
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Smoking status
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Current
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Never
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Previous
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P* Current vs Never
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P** Current vs Previous
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Number, n (%)
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21 (20)
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62 (61)
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14 (14)
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Age, median (IQR), years
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36 (31.5-43.5)
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41 (33.7-50.2)
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49 (38.2-56.3)
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0.15
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0.01
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Women, n (%)
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10 (15.9)
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47 (74.6)
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3 (4.8)
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0.02
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0.12
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Disease duration, median (IQR), years
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0.87 (0.3-6.5)
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3.4 (0.7-7.8)
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3.3 (1.9-11.1)
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0.11
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0.06
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Follow up time, median (IQR) years
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1.8 (0.3-2.5)
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1.3 (0.2-2.4)
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1.1 (0.4-1.5)
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0.31
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0.21
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Body Mass Index, kg/m2 median (IQR)
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27.8 (25.3-31.8)
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28.7 (26.9-31.2)
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29.5 (24.8- 35.6)
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0.68
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0.76
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CRP, mg/L, median (IQR)
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15 (3-33)
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12 (5-18.5)
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12 (4-26.5)
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0.83
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0.87
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ESR, mm/h, median (IQR)
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20 (7-40.5)
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34 (22-49)
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29.5 (18.5-58.5)
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0.05
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0.37
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DAS28CRP, median (IQR)
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4.4 (3.5-4.7)
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4.2 (3.6-4.9)
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4.5 (3.3-4.9)
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0.87
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0.60
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CDAI, median (IQR)
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19 (12.7-24)
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17.6 (11.9-23.2)
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14.5 (8.9-21.3)
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07.7
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0.23
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HAQ, median (IQR)
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0.75 (0.6-0.9)
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0.7 (0.7-1)
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0.75 (0.75-0.9)
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0.40
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0.68
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Treatment adherence, median (IQR), years
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1.1 (0.3-2.3)
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1.1 (0.2-1.9)
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0.8 (0.4-1.2)
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0.57
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0.52
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Discontinue reason n, (%)
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Adverse events
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1 (17)
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1 (6)
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0 (0)
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0.70
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0.70
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Lack of efficacy
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2 (33)
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6 (38)
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2 (50)
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Other
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3 (50)
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9 (56)
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2 (50)
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EULAR- good response, n, (%)
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10 (23,3)
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26 (60,5)
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7 (16.3)
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0.6
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0.90
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To cite this abstract in AMA style:
Yarkan H, Kenar G, Capar S, Can G, Zengin B, Akar S, Dalkiliç E, Senel S, Koca SS, Tufan A, Yazici A, İnanç N, Ellidokuz H, Akkoc N, Onen F. The Effect of Smoking on Response to Tumour Necrosis Factor-Alpha Inhibitor Treatment in Psoriatic Arthritis Patients: Results from the Turkbio Registry [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/the-effect-of-smoking-on-response-to-tumour-necrosis-factor-alpha-inhibitor-treatment-in-psoriatic-arthritis-patients-results-from-the-turkbio-registry/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effect-of-smoking-on-response-to-tumour-necrosis-factor-alpha-inhibitor-treatment-in-psoriatic-arthritis-patients-results-from-the-turkbio-registry/