PT  - JOURNAL ARTICLE
AU  - Højgaard, Pil
AU  - Glintborg, Bente
AU  - Hetland, Merete Lund
AU  - Hansen, Torben Højland
AU  - Lage-Hansen, Philip Rask
AU  - Petersen, Martin H
AU  - Holland-Fischer, Mette
AU  - Nilsson, Christine
AU  - Loft, Anne Gitte
AU  - Andersen, Bjarne Nesgaard
AU  - Adelsten, Thomas
AU  - Jensen, Jørgen
AU  - Omerovic, Emina
AU  - Christensen, Regitse
AU  - Tarp, Ulrik
AU  - Østgård, René
AU  - Dreyer, Lene
TI  - Association between tobacco smoking and response to tumour necrosis factor α inhibitor treatment in psoriatic arthritis: results from the DANBIO registry
AID  - 10.1136/annrheumdis-2014-205389
DP  - 2015 Dec 01
TA  - Annals of the Rheumatic Diseases
PG  - 2130--2136
VI  - 74
IP  - 12
4099  - http://ard.bmj.com/content/74/12/2130.short
4100  - http://ard.bmj.com/content/74/12/2130.full
SO  - Ann Rheum Dis2015 Dec 01; 74
AB  - 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.