Impact of tobacco smoking on response to tumour necrosis factor-alpha inhibitor treatment in patients with ankylosing spondylitis: results from the Danish nationwide DANBIO registry

Glintborg, Bente; Højgaard, Pil; Hetland, Merete Lund; Krogh, Niels Steen; Kollerup, G.; Jensen, Jens‐Erik Beck; Chrysidis, Stavros; Hansen, Inger Marie Jensen; Holland-Fischer, Mette; Hansen, Therese; Nilsson, Christine; Espesen, Jakob; Nordin, Henrik; Loft, Anne Gitte; Pelck, Randi; Lorenzen, Tove; Oeftiger, Sussi Maria Flejsborg; Unger, Barbara; Jaeger, Frank; Petersen, Peter M.; Rasmussen, Claus; Dreyer, Lene

doi:10.1093/rheumatology/kev392

Cited by 62 publications

(62 citation statements)

References 42 publications

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“…[25,26] An observational cohort study in 1576 Danish AS patient showed that current and previous smokers had worse treatment response to TNF-α inhibitors than never smokers. [27] Components of tobacco smoke can activate immune responses leading to higher secretion of pro-inflammatory cytokines. More inflammation and functional impairment may result in more new bone formation.…”

Section: Discussionmentioning

confidence: 99%

Ankylosing spondylitis patients at risk of poor radiographic outcome show diminishing spinal radiographic progression during long-term treatment with TNF-α inhibitors

et al. 2017

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ObjectiveTo investigate the influence of patient characteristics on the course of spinal radiographic progression in a large prospective longitudinal cohort study of ankylosing spondylitis (AS) patients treated long-term with TNF-α inhibitors.MethodsConsecutive patients from the Groningen Leeuwarden AS (GLAS) cohort starting TNF-α inhibitors with spinal radiographs at least available at baseline and 6 years of follow-up were included. Radiographs were scored using mSASSS by two independent readers. Generalized estimating equations (GEE) were used to explore the associations between baseline characteristics and spinal radiographic progression. The course of radiographic progression in patients with and without risk factors for poor radiographic outcome was investigated using different time models (linear and non-linear). Single linear imputation was used in case of missing radiographic data at the intermediate (2 or 4 years) follow-up visits.Results80 AS patients were included with mean baseline mSASSS 8.7±13.3. Baseline syndesmophytes, male gender, older age, longer symptom duration, smoking, and higher BMI were significantly associated with more radiographic damage over time. GEE analysis in patients with these risk factors revealed that radiographic progression followed a non-linear course with mean mSASSS progression rates reducing from max. 2.8 units over 0–2 years to min. 0.9 units over 4–6 years. The GEE model revealed a linear course with overall very low progression (≤1 mSASSS units/2yrs) in patients without risk factors. Complete case analysis in 53 patients showed similar results.ConclusionAS patients at risk of poor radiographic outcome showed the highest but diminishing spinal radiographic progression during long-term treatment with TNF-α inhibitors.

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Section: Discussionmentioning

confidence: 99%

Ankylosing spondylitis patients at risk of poor radiographic outcome show diminishing spinal radiographic progression during long-term treatment with TNF-α inhibitors

et al. 2017

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“…Moreover, patients were recruited based on the diagnosis of expert treating rheumatologists and not on classification criteria. This could be considered an inherent limitation of most registries, wherein, comparable to our study, patients are included based on treating rheumatologists' diagnoses 10,15,27,28 . Nevertheless, we have to note that most of our patients had established, longstanding diseases; they were all followed by experienced rheumatologists, and baseline demographics and disease characteristics are well in accordance with available epidemiologic data and those reported by other registries 14,29,30 .…”

Section: Rheumatologymentioning

confidence: 99%

“…However, other response indices (ASDAS-ID, DAS28-inactive state, and ACR70) were not found to be associated with BMI (data not shown). Regarding smoking, conflicting available data exist in the literature, supporting either a negative effect or no role in drug survival 16,27 . In our cohort, both in univariate and multivariable regression analyses of available data (n = 234, 55% current, 12% past smokers, 33% never smoked), smoking status (treated either as ever/never or as non/past/current smoking) was not a significant predictor for TNFi survival overall (data not shown).…”

Section: Rheumatologymentioning

confidence: 99%

Comparative Analysis and Predictors of 10-year Tumor Necrosis Factor Inhibitors Drug Survival in Patients with Spondyloarthritis: First-year Response Predicts Longterm Drug Persistence

Flouri

Markatseli²,

Boki³

et al. 2018

J Rheumatol

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Objective.To evaluate the 10-year drug survival of the first tumor necrosis factor inhibitor (TNFi) administered to patients with spondyloarthritis (SpA) overall and comparatively between SpA subsets, and to identify predictors of drug retention.Methods.Patients with SpA in the Hellenic Registry of Biologic Therapies, a prospective multicenter observational cohort, starting their first TNFi between 2004–2014 were analyzed. Kaplan-Meier curves and Cox regression models were used.Results.Overall, 404 out of 1077 patients (37.5%) discontinued treatment (followup: 4288 patient-yrs). Ten-year drug survival was 49%. In the unadjusted analyses, higher TNFi survival was observed in patients with ankylosing spondylitis (AS) compared to undifferentiated SpA and psoriatic arthritis [PsA; significant beyond the first 2.5 (p = 0.003) years and 7 years (p < 0.001), respectively], and in patients treated for isolated axial versus peripheral arthritis (p = 0.001). In all multivariable analyses, male sex was a predictor for longer TNFi survival. Use of methotrexate (MTX) was a predictor in PsA and in patients with peripheral arthritis. Absence of peripheral arthritis and use of a monoclonal antibody (as opposed to non-antibody TNFi) independently predicted longer TNFi survival in axial disease because of lower rates of inefficacy. Achievement of major responses during the first year in either axial or peripheral arthritis was the strongest predictor of longer therapy retention (HR 0.33, 95% CI 0.26–0.41 for Ankylosing Spondylitis Disease Activity Score inactive disease, and HR 0.35, 95% CI 0.24–0.50 for 28-joint Disease Activity Score remission).Conclusion.The longterm retention of the first TNFi administered to patients with SpA is high, especially for males with axial disease. The strongest predictor of longterm TNFi survival is a major response within the first year of treatment.

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“…However, these registries more often address rheumatoid arthritis than axSpA. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] While retention rates for anti-TNFs have been investigated using several patient registries, their follow-up duration did not typically exceed 8 years. 4,5 Young age, male gender and presence of inflammatory syndrome appeared predictive of retention in most, ALthough not all cases.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 Young age, male gender and presence of inflammatory syndrome appeared predictive of retention in most, ALthough not all cases. 4,7,11,12,19 Other debated factors include the anti-TNF type prescribed, presence of other arthritis forms, and using conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) in combination with anti-TNF therapy. 10,11,14,16 In the event of treatment failure with a single anti-TNF, certain registries have assessed the efficacy of a second anti-TNF, ALthough with little data available on long-term retention.…”

Section: Introductionmentioning

confidence: 99%

Retention rates of adalimumab, etanercept, and infliximab as first‐ or second‐line biotherapies for spondyloarthritis patients in daily practice in Auvergne (France)

et al. 2018

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Impact of tobacco smoking on response to tumour necrosis factor-alpha inhibitor treatment in patients with ankylosing spondylitis: results from the Danish nationwide DANBIO registry

Abstract: In this study of TNFi-treated AS patients in clinical practice, current and previous smokers had significantly poorer patient-reported outcomes at baseline, shorter treatment adherence and poorer treatment response compared with never smokers.

Cited by 62 publications

References 42 publications

Ankylosing spondylitis patients at risk of poor radiographic outcome show diminishing spinal radiographic progression during long-term treatment with TNF-α inhibitors

Ankylosing spondylitis patients at risk of poor radiographic outcome show diminishing spinal radiographic progression during long-term treatment with TNF-α inhibitors

Comparative Analysis and Predictors of 10-year Tumor Necrosis Factor Inhibitors Drug Survival in Patients with Spondyloarthritis: First-year Response Predicts Longterm Drug Persistence

Retention rates of adalimumab, etanercept, and infliximab as first‐ or second‐line biotherapies for spondyloarthritis patients in daily practice in Auvergne (France)

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