Mattey Derek L, Brownfield Ann, Dawes Peter T
Staffordshire Rheumatology Centre, University Hospital of North Staffordshire, and Institute of Science and Technology in Medicine, Keele University, Keele, Staffordshire, UK.
J Rheumatol. 2009 Jun;36(6):1180-7. doi: 10.3899/jrheum.081096. Epub 2009 May 15.
To determine whether there is a quantitative relationship between smoking history and response to therapy with tumor necrosis factor (TNF) antagonists.
A history of cigarette smoking was obtained from a questionnaire completed by each patient starting therapy with TNF antagonists since 2002 (n=154). A core set of demographic and clinical variables was recorded at baseline and at 3 and 12 months. The extent of smoking was quantified in pack-years (py), with 1 py equivalent to 20 cigarettes per day for 1 year. The association between smoking intensity and response was assessed using contingency tables and logistic regression analysis. Response to therapy was defined according to the European League Against Rheumatism improvement criteria.
There was an increasing trend of no response at 3 and 12 months with increasing py history [p (trend)=0.008 and 0.003, respectively]. The change in Disease Activity Score (DAS)28 over the first 3 months was inversely associated with the number of py (r=-0.28, p=0.002). The association of py history with response failure was independent of age, sex, disease duration, baseline disease activity score (DAS28), Health Assessment Questionnaire (HAQ) score, IgM rheumatoid factor, and smoking at baseline. The most significant effect was seen in patients treated with infliximab.
RA patients with a history of smoking were more likely to show a poor response to TNF antagonists. Response failure was associated with the intensity of previous smoking, irrespective of smoking status at initiation of anti-TNF therapy.
确定吸烟史与肿瘤坏死因子（TNF）拮抗剂治疗反应之间是否存在定量关系。
自2002年起，从开始接受TNF拮抗剂治疗的每位患者填写的问卷中获取吸烟史（n = 154）。在基线、3个月和12个月时记录一组核心的人口统计学和临床变量。吸烟程度以包年（py）量化，1个包年相当于每天吸20支烟，持续1年。使用列联表和逻辑回归分析评估吸烟强度与治疗反应之间的关联。根据欧洲抗风湿病联盟的改善标准定义治疗反应。
随着包年史增加，在3个月和12个月时无反应的趋势增加[p（趋势）分别为0.008和0.003]。前3个月疾病活动评分（DAS）28的变化与包年数呈负相关（r = -0.28，p = 0.002）。包年史与治疗失败的关联独立于年龄、性别、病程、基线疾病活动评分（DAS28）健康评估问卷（HAQ）评分、IgM类风湿因子以及基线时的吸烟情况。在接受英夫利昔单抗治疗的患者中观察到最显著的影响。
有吸烟史的类风湿关节炎患者对TNF拮抗剂的反应更可能较差。治疗失败与既往吸烟强度相关，与抗TNF治疗开始时的吸烟状态无关。
