Smoking and Early Infliximab Response in Crohn's Disease: a Meta-analysis

Inamdar, Sumant; Volfson, Ariy; Rosen, Lisa; Sunday, Suzanne R.; Katz, Seymour; Sultan, Keith

doi:10.1093/ecco-jcc/jju018

Cited by 17 publications

(10 citation statements)

References 30 publications

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“…However further data supporting a detrimental impact on treatment outcomes per se are surprisingly sparse. For instance, 2 large meta-analyses were unable to depict an effect of smoking status on response to infliximab, 22,23 and smoking, if anything, may have a positive impact on thiopurine metabolism and related treatment response.…”

Section: Discussionmentioning

confidence: 99%

“…Eight of these showed no difference in response and relapse rates for both luminal and fistulizing CD although the remaining 2 studies demonstrated that smokers had reduced early response rates and shorter time to relapse. Also, a more recent meta-analysis examining the impact of smoking on early response to infliximab by Inamdar et al 23 www.irjournal.org analyzed 8 studies, comprising 1,658 patients. Most were prospective studies and assessed both luminal and fistulizing CD.…”

Section: Anti-tnf Agentsmentioning

confidence: 99%

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The impact of tobacco smoking on treatment choice and efficacy in inflammatory bowel disease

et al. 2021

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horts. 3 It is well established that smoking significantly increases the risk of developing and worsens the disease course of CD, yet is protective against the development and reduces the severity of ulcerative colitis (UC). 4,5 However, what is less clear is whether smoking impacts the efficacy of therapeutics in IBD. Given the increased choice and availability of therapies with differing mechanisms of action, it may be surmised that for patients who continue smoking (i.e., failing efforts at cessation as is often encountered) there may be a preferred treatment option given a potential differential impact (positive, negative, or neutral) of smoking on individual treatments. Hence, the aim of this paper was to review the literature regarding the relationship between smoking and the efficacy of medical and surgical therapies in IBD, with particular reference to CD. A proposed algorithm for the approach to the management of IBD in smokers is proposed based on this review (Fig. 1).

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Section: Discussionmentioning

confidence: 99%

Section: Anti-tnf Agentsmentioning

confidence: 99%

The impact of tobacco smoking on treatment choice and efficacy in inflammatory bowel disease

et al. 2021

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“…In addition, a recursive search identified other potentially eligible studies among the bibliographies of selected articles. Finally, we searched the bibliographies of previous systematic reviews in this area . Eligibility was judged by two independent investigators with any disagreements resolved by a third investigator.…”

Section: Methodsmentioning

confidence: 99%

“…Finally, we searched the bibliographies of previous systematic reviews in this area. [18][19][20][21][22][23][24][25] Eligibility was judged by two independent investigators with any disagreements resolved by a third investigator.…”

Section: Methodsmentioning

confidence: 99%

Systematic review with meta‐analysis: the adverse effects of tobacco smoking on the natural history of Crohn's disease

Gracie

Ford

2016

Aliment Pharmacol Ther

143

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Summary Background Tobacco smoking is a well‐established risk factor for the development of Crohn's disease, and this may lead to a more complicated disease course. However, recent evidence suggests that many patients with Crohn's disease are unaware of this fact. Aim To perform a systematic review and meta‐analysis of the effects of smoking on disease course in Crohn's disease. Methods A search of MEDLINE, EMBASE and EMBASE classic was carried out (up to July 2015) to identify observational studies reporting data on smoking and rates of surgery or flares of disease activity in patients with Crohn's disease. Dichotomous data were pooled to obtain odds ratios (ORs) for flares of disease activity or need for surgery, with 95% confidence intervals (CIs). Results The search identified 33 eligible studies. Compared with nonsmokers, smokers had increased odds of flare of disease activity (OR, 1.56; 95% CI, 1.21–2.01), flare after surgery (OR, 1.97; 95% CI, 1.36–2.85), need for first surgery (OR, 1.68; 95% CI, 1.33–2.12) and need for second surgery (OR, 2.17; 95% CI, 1.63–2.89). The odds of these outcomes among ex‐smokers diminished upon smoking cessation, with ORs comparable to those among nonsmokers and, in the case of flare or second surgery, significantly lower than smokers. Conclusions Smokers with Crohn's disease have a more complicated disease course than nonsmokers, and quitting smoking may ameliorate this. Patients should be reminded of the detrimental effects of smoking on the course of their disease, and smoking cessation advice should be provided to reduce disease burden and costs in these patients.

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“…Smokers with CD have a more complicated disease course and discontinuation led to better outcomes ( 32 – 34 ). Although, some studies have indicated worse outcomes of anti-TNF treated smoking CD patients in comparison to non-smokers ( 35 , 36 ), two meta-analyses found no effect of smoking on primary effectiveness of infliximab in CD patients ( 37 , 38 ). In UC, smokers have reduced colectomy rates, less primary sclerosing cholangitis and less back-wash ileitis than never smokers ( 39 ).…”

Section: Patient and Disease Related Predictors To Anti-tnf Therapymentioning

confidence: 99%

Personalizing Treatment in IBD: Hype or Reality in 2020? Can We Predict Response to Anti-TNF?

2020

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The advent of anti-TNF agents as the first approved targeted therapy in the treatment of inflammatory bowel disease (IBD) patients has made a major impact on our existing therapeutic algorithms. They have not only been approved for induction and maintenance treatment in IBD patients, but have also enabled us to define and achieve novel therapeutic outcomes, such as combination of clinical symptom control and endoscopic remission, as well as mucosal healing. Nevertheless, approximately one third of treated patients do not respond to initiated anti-TNF therapy and these treatments are associated with sometimes severe systemic side-effects. There is therefore the currently unmet clinical need do establish predictive markers of response to identify the subgroup of IBD patients, that have a heightened probability of response. There have so far been approaches from different fields of IBD research, to descry markers that would empower us to apply TNF-inhibitors in a more rational manner. These markers encompass findings from disease-related and clinical factors, pharmacokinetics, biochemical markers, blood and stool derived parameters, pharmacogenomics, microbial species, metabolic compounds, and mucosal factors. Furthermore, changes in the intestinal immune cell composition in response to therapeutic pressure of anti-TNF treatment have recently been implicated in the process of molecular resistance to these drugs. Insights into factors that determine resistance to anti-TNF therapy give reasonable hope, that a more targeted approach can then be utilized in these non-responders. Here, IL-23 could be identified as one of the key factors determining resistance to TNF-inhibitors. Growing insights into the molecular mechanism of action of TNF-inhibitors might also enable us to derive critical molecular markers that not only mediate the clinical effects of anti-TNF therapy, but which level of expression might also correlate with its therapeutic efficacy. In this narrative review, we present an overview of currently identified possible predictive markers for successful anti-TNF therapy and discuss identified molecular pathways that drive resistance to these substances. We will also point out the necessity and difficulty of developing and validating a diagnostic marker concerning clinically relevant outcome parameters, before they can finally enter daily clinical practice and enable a more personalized therapeutic approach.

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Smoking and Early Infliximab Response in Crohn's Disease: a Meta-analysis

Abstract: Though smoking worsens CD, this meta-analysis does not show a negative effect of smoking on initial response to infliximab. This must be viewed in the proper context, as long-term maintenance of response may yet be influenced by smoking status.

Cited by 17 publications

References 30 publications

The impact of tobacco smoking on treatment choice and efficacy in inflammatory bowel disease

The impact of tobacco smoking on treatment choice and efficacy in inflammatory bowel disease

Systematic review with meta‐analysis: the adverse effects of tobacco smoking on the natural history of Crohn's disease

Personalizing Treatment in IBD: Hype or Reality in 2020? Can We Predict Response to Anti-TNF?

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