Sat0396 influence of Smoking and Obesity on Therapeutic Response in Patients With Axial Spondyloarthritis: A Systematic Literature Review

Abstract

Background:Biological therapies have substantially improved the prognosis of patients with Spondyloarthritis (SpA). However, a satisfactory clinical response is not achieved in all patients and it is essential for the clinician to identify all those factors that predict treatment response. Although they are supposed as unfavorable and potentially avoidable factors, the influence of smoking and obesity as predictors of treatment response in SpA is unknown.Objectives:To determine if smoking and obesity are factors of worse therapeutic response in patients with axial spondyloarthritis (axSpA).Methods:Systematic review of the literature in MEDLINE and EMBASE until June 30, 2019 based on the PICO design method. Population (P): patients with axSpA. Intervention (I): smoking or obesity. Comparator (C): non-smokers and normal weight. Outcome (O): any of the response criteria currently validated for axSpA. A specific excel form was used for data collection, EndNote software for the management and organization of papers and the Oxford 2009 level for evidence evaluation.Results:1873 citations were recovered, 46 studies were selected for full-text review and 12 for data extraction: 6 for smoking and 6 for obesity. The design of all studies was observational and longitudinal with data from national registries except one cross-sectional. In total, these studies included 5291 patients (3917 patients for smoking and 1333 patients for obesity), all treated with a TNF inhibitor (iTNF). The Oxford level of evidence for all studies was 2b except the cross-sectional study, which was 4. Regarding smoking, the evidence found is not consistent. Two of the studies concluded an unfavorable effect on the response to the iTNF (Glintborg and Ciurea) but the remaining 4 studies found no differences in the clinical response to iTNF (Zhao), the cause of discontinuity of the iTNF (Zhao, Hernandez) or quality of life indexes (Kydd). For obesity, the evidence is more consistent, so that 5 of the 6 studies observed a negative influence on the therapeutic response to iTNF (Ottaviani, Gremese, Micheroli, Hernández-Breijo and Rosas).Conclusion:According to scientific evidence in patients with axSpA, obesity is associated with a worse therapeutic response to iTNF. However, this negative effect is not clearly evidenced for smoking.Disclosure of Interests:Pablo Zurita-Prada: None declared, Claudia Urrego-Laurín: None declared, Carlos Guillén-Astete: None declared, Victoria Navarro-Compán Consultant of: Abbvie, Lilly, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Lilly, Novartis, Pfizer, UCB