RT Journal Article SR Electronic T1 Impaired response to treatment with tumour necrosis factor α inhibitors in smokers with axial spondyloarthritis JF Annals of the Rheumatic Diseases JO Ann Rheum Dis FD BMJ Publishing Group Ltd and European League Against Rheumatism SP 532 OP 539 DO 10.1136/annrheumdis-2013-205133 VO 75 IS 3 A1 Adrian Ciurea A1 Almut Scherer A1 Ulrich Weber A1 Pascale Exer A1 Jürg Bernhard A1 Giorgio Tamborrini A1 Myriam Riek A1 Rüdiger B Müller A1 Bettina Weiss A1 Michael J Nissen A1 Rudolf Kissling A1 Beat A Michel A1 Axel Finckh YR 2016 UL http://ard.bmj.com/content/75/3/532.abstract AB Objectives To investigate the impact of smoking on the response to treatment with a first tumour necrosis factor inhibitor (TNFi) in patients with axial spondyloarthritis (axSpA) in a real-life cohort.Methods Patients fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA in the Swiss Clinical Quality Management Cohort were included in this study. The potential association between smoking status and differential response to TNFi in terms of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) was analysed using multiple adjusted longitudinal mixed effect models. Binary response rates at 1 year were assessed with multiple adjusted logistic analyses.Results A first TNFi was initiated in 698 patients with axSpA with available smoking status and a baseline or follow-up BASDAI assessment, of which 490 (70%) had complete covariate data. In comparison to non-smokers, current smokers demonstrated significantly smaller reductions in BASDAI and ASDAS scores upon treatment with TNFi (0.75 BASDAI units and 0.69 ASDAS units less, p=0.005 and 0.001, respectively) for patients with elevated baseline C-reactive protein (CRP) level. This effect was numerically smaller in patients with normal CRP. The odds for reaching a 50% improvement in BASDAI response or the ASAS criteria for 40% improvement after 1 year were significantly lower in current smokers than in non-smokers (0.54, 95% CI 0.31 to 0.95, p=0.03 and 0.43, 95% CI 0.24 to 0.76, p=0.004, respectively).Conclusions Current smoking is associated with an impaired response to TNFi in axSpA.