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THU0185 Smoking does not Influence Response to Anti-TNF Treatment with Adalimumab or Etanercept in Patients with Rheumatoid Arthritis
  1. C. Krieckaert1,
  2. I. Visman1,
  3. M. l’Ami1,
  4. M. Abbas1,
  5. M. Nurmohamed1,2
  1. 1Rheumatology, Jan Van Breemen Research Institute | Reade
  2. 2Internal Medicine, VU medical center, Amsterdam, Netherlands


Background Smoking is associated with an increased risk of developing rheumatoid arthritis (RA) and with poor treatment outcome in early as well as established RA.[1-3]

Objectives To investigate the effect of smoking on response to the TNF inhibitors etanercept and adalimumab in patients RA.

Methods Eight hundred sixty eight patients with RA, consecutively included in a prospective observational cohort were followed for 6 months. Patients were treated with either adalimumab or etanercept and drug choice was at the discretion of the treating rheumatologist. Smoking status was recorded at baseline.

Results Four hundred seventy three patients started with etanercept treatment (55%) and 395 started with adalimumab treatment (44%). In total, 226 patients (31%) were current smokers and smoked a median of 10 cigarettes per day (IQR 6-20), with a median (IQR) of 19.5 (7-31.5) pack years. An additional 296 patients had smoked cigarettes in the past for a median (IQR) of 20 (10-30) years. Baseline DAS28 did not differ between smokers and non-smokers mean (SD) 4.8 (1.3) vs. 5.0 (1.3), respectively (p=0.15). After 4 months of treatment, 33% of patients had achieved minimal disease activity defined as a DAS28<2.6 and this did not differ between smokers and non-smokers (34% vs. 33%, p=0.81). At 6 months of treatment, these results remained the same: 33% for the total patient population, 34% and 33% for smokers and non-smokers, respectively (p=0.74). In addition, pack years was not associated with EULAR response at 4 and 6 months of treatment.

Conclusions In contrast to previous studies, in our cohort of adalimumab and etanercept treated patients with RA there was no negative effect of smoking on treatment response.


  1. Yahya A et al. Mod Rheumatol. 2012 Aug;22(4):524-31.

  2. Rojas-Serrano J et al. Clin Rheumatol. 2011 Dec;30(12):1589-93.

  3. Söderlin MK et al. Scand J Rheumatol. 2012 Feb;41(1):1-9.

Disclosure of Interest C. Krieckaert: None Declared, I. Visman: None Declared, M. l’Ami: None Declared, M. Abbas: None Declared, M. Nurmohamed Consultant for: Abbott, Roche, Pfizer, MSD, UCB, SOBI, BMS, Speakers bureau: Abbott, Roche, Pfizer

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