Psoriatic Arthritis: Smoking Decreases Treatment Response

Dr. Bente Glintborg: Copenhagen Centre for Arthritis Research Centre for Rheumatology and Spine Diseases Copenhagen University Hospital Glostrup Copenhagen, Denmark MedicalResearch.com: Interview Invitation
Dr. Bente Glintborg:
Copenhagen Centre for Arthritis Research
Centre for Rheumatology and Spine Diseases
Copenhagen University Hospital Glostrup
Copenhagen, Denmark

Medical Research: What are the main findings of the study?

Dr. Glintborg: Current smoking had a negative impact among patients with psoriatic arthritis treated with TNFi. This was especially observed among male patients and among patients treated with infliximab and etanercept. Current smokers had a shorter treatment duration (=poorer treatment adherence rate) compared to non-smokers. And current smokers had poorer treatment response (measured as ACR20, ACR50 and ACR70 responses and EULAR good response) compared to non smokers. Especially among male smokers the EULAR good response and ACR20 response rates were nearly half of the rates among male non-smokers. The response rates among women did not seem to be affcted by smoking status. Current smokers had poorer self reported outcome measures (HAQ and VAS global and VAS fatigue) when they started treatment with TNFi.

Medical Research: Were any of the findings unexpected?

Dr. Glintborg: It was unexpected that smoking status mainly affected response rates and treatment duration among men but not among women.

Medical Research: What should clinicians and patients take away from your report?

Dr. Glintborg: Smoking is a potential modifiable risk factor that affects the impact of TNFi treatment response. In the current study, previous smokers who had stopped smoking more than 4-5 years ago imitated never smokers and had similar treatment duration. Thus the impact of smoking seems to be potentially reversible. For this – and several other reasons, it is important to encourage smoking cessation in these patients.
Smoking status seems to affect patient reported outcome measures (higher HAQ and VAS scores) and this might affect the clinical evaluation of this patient group.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Glintborg: In order to investigate the impact of smoking among patients with psoriatic arthritis, further observational studies should preferably include information regarding relevant confounders (e.g. comorbidities and psycosocial factors) and should include more detailed information about outcome measures (68-joint count, enthesitis, psoriatic skin involvement, axial disease activity).

Citation:

Association between tobacco smoking and response to tumour necrosis factor α inhibitor treatment in psoriatic arthritis: results from the DANBIO registry

Pil Højgaard, Bente Glintborg, Merete Lund Hetland, Torben Højland Hansen, Philip Rask Lage-Hansen, Martin H Petersen, Mette Holland-Fischer, Christine Nilsson, Anne Gitte Loft, Bjarne Nesgaard Andersen, Thomas Adelsten, Jørgen Jensen, Emina Omerovic, Regitse Christensen, Ulrik Tarp, René Østgård, Lene Dreyer

Ann Rheum Dis annrheumdis-2014-205389Published Online First: 25 July 2014