Pil Højgaard1, Bente Glintborg2, Merete Lund Hetland3, Torben Højland Hansen4, Philip Rask Lage-Hansen5, Martin H Petersen6, Mette Holland-Fischer7, Christine Nilsson8, Anne Gitte Loft9, Bjarne Nesgaard Andersen10, Thomas Adelsten11, Jørgen Jensen12, Emina Omerovic13, Regitse Christensen14, Ulrik Tarp15, René Østgård16, Lene Dreyer17. 1. Department of Rheumatology, Gentofte Hospital, Copenhagen, Denmark Department of Rheumatology, Frederiksberg Hospital, Copenhagen, Denmark. 2. Department of Rheumatology, Gentofte Hospital, Copenhagen, Denmark Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Denmark The Danish Rheumatologic Database (DANBIO), Copenhagen University Hospital Glostrup, Denmark. 3. Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Denmark The Danish Rheumatologic Database (DANBIO), Copenhagen University Hospital Glostrup, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. 4. Department of Rheumatology, Holbæk Hospital, Holbæk, Denmark. 5. Department of Rheumatology, Esbjerg Hospital, Esbjerg, Denmark. 6. Department of Rheumatology, Svendborg Hospital, Svendborg, Denmark. 7. Department of Rheumatology, Aalborg University Hospital, Aalborg,Denmark. 8. Department of Rheumatology, Odense University Hospital, Odense, Denmark. 9. Department of Rheumatology, Vejle Sygehus, Sygehus Lillebælt, Vejle, Denmark. 10. Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen, Denmark. 11. Department of Rheumatology, Helsingør and Hillerød Hospital, Hillerød, Denmark. 12. Department of Rheumatology, Køge Hospital, Køge, Denmark. 13. Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Denmark. 14. Department of Rheumatology, Gentofte Hospital, Copenhagen, Denmark. 15. Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark. 16. Department of Rheumatology, Silkeborg Hospital, Denmark. 17. Department of Rheumatology, Gentofte Hospital, Copenhagen, Denmark The Danish Rheumatologic Database (DANBIO), Copenhagen University Hospital Glostrup, Denmark.
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. 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/
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. 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/
Authors: Juan Carlos Torre-Alonso; Loreto Carmona; Mireia Moreno; Eva Galíndez; Jesús Babío; Pedro Zarco; Luis Linares; Eduardo Collantes-Estevez; Manuel Fernández Barrial; Juan Carlos Hermosa; Pablo Coto; Carmen Suárez; Raquel Almodóvar; Jesús Luelmo; Santos Castañeda; Jordi Gratacós Journal: Rheumatol Int Date: 2017-04-07 Impact factor: 2.631