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Association between tobacco smoking and response to tumour necrosis factor α inhibitor treatment in psoriatic arthritis: results from the DANBIO registry
  1. Pil Højgaard1,2,
  2. Bente Glintborg1,3,4,
  3. Merete Lund Hetland3,4,5,
  4. Torben Højland Hansen6,
  5. Philip Rask Lage-Hansen7,
  6. Martin H Petersen8,
  7. Mette Holland-Fischer9,
  8. Christine Nilsson10,
  9. Anne Gitte Loft11,
  10. Bjarne Nesgaard Andersen12,
  11. Thomas Adelsten13,
  12. Jørgen Jensen14,
  13. Emina Omerovic3,
  14. Regitse Christensen1,
  15. Ulrik Tarp15,
  16. René Østgård16,
  17. Lene Dreyer1,4
  1. 1Department of Rheumatology, Gentofte Hospital, Copenhagen, Denmark
  2. 2Department of Rheumatology, Frederiksberg Hospital, Copenhagen, Denmark
  3. 3Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Denmark
  4. 4The Danish Rheumatologic Database (DANBIO), Copenhagen University Hospital Glostrup, Denmark
  5. 5Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  6. 6Department of Rheumatology, Holbæk Hospital, Holbæk, Denmark
  7. 7Department of Rheumatology, Esbjerg Hospital, Esbjerg, Denmark
  8. 8Department of Rheumatology, Svendborg Hospital, Svendborg, Denmark
  9. 9Department of Rheumatology, Aalborg University Hospital, Aalborg,Denmark
  10. 10Department of Rheumatology, Odense University Hospital, Odense, Denmark
  11. 11Department of Rheumatology, Vejle Sygehus, Sygehus Lillebælt, Vejle, Denmark
  12. 12Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen, Denmark
  13. 13Department of Rheumatology, Helsingør and Hillerød Hospital, Hillerød, Denmark
  14. 14Department of Rheumatology, Køge Hospital, Køge, Denmark
  15. 15Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
  16. 16Department of Rheumatology, Silkeborg Hospital, Denmark
  1. Correspondence to Dr Bente Glintborg, Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Copenhagen, Denmark; glintborg{at}


Objectives To investigate the association between tobacco smoking and disease activity, treatment adherence and treatment responses among patients with psoriatic arthritis (PsA) initiating the first tumour necrosis factor α inhibitor therapy (TNFi) in routine care.

Methods Observational cohort study based on the Danish nationwide DANBIO registry. Kaplan–Meier plots, logistic and Cox regression analyses by smoking status (current/previous/never smoker) were calculated for treatment adherence, ACR20/50/70-responses and EULAR-good-response. Additional stratified analyses were performed according to gender and TNFi-subtype (adalimumab/etanercept/infliximab).

Results Among 1388 PsA patients included in the study, 1148 (83%) had known smoking status (33% current, 41% never and 26% previous smokers). Median follow-up time was 1.22 years (IQR 0.44–2.96). At baseline, current smokers had lower Body Mass Index (27 kg/m2 (23–30)/28 kg/m2 (24–31)) (median (IQR)), shorter disease duration (3 years (1–8)/5 years (2–10)), lower swollen joint count (2 (0–5)/3 (1–6)), higher visual-analogue-scale (VAS) patient global (72 mm (54–87)/68 mm (50–80)), VAS fatigue (72 mm (51–86)/63 mm (40–77)) and Health Assessment Questionnaire (HAQ) score (1.1 (0.7 to 1.5)/1.0 (0.5 to 1.5)) than never smokers (all p<0.05). Current smokers had shorter treatment adherence than never smokers (1.56 years (0.97 to 2.15)/2.43 years (1.88 to 2.97), (median (95% CI)), log rank p=0.02) and poorer 6 months’ EULAR-good-response rates (23%/34%), ACR20 (24%/33%) and ACR50 response rates (17%/24%) (all p<0.05), most pronounced in men. In current smokers, the treatment adherence was poorer for infliximab (HR) 1.62, 95% CI 1.06 to 2.48) and etanercept (HR 1.74, 1.14 to 2.66) compared to never smokers, but not for adalimumab (HR 0.80, 0.52 to 1.23).

Conclusion In PsA, smokers had worse baseline patient-reported outcomes, shorter treatment adherence and poorer response to TNFi's compared to non-smokers. This was most pronounced in men and in patients treated with infliximab or etanercept.

  • TNF-alpha
  • Psoriatic Arthritis
  • Smoking
  • Treatment
  • Outcomes research

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