Department of Rheumatology, University Hospital, Zurich, Switzerland.
Swiss Clinical Quality Management Foundation, Zurich, Switzerland.
Ann Rheum Dis. 2016 Mar;75(3):532-9. doi: 10.1136/annrheumdis-2013-205133. Epub 2015 Feb 9.
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.
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.
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).
Current smoking is associated with an impaired response to TNFi in axSpA.
在真实队列中，研究吸烟对接受首种肿瘤坏死因子抑制剂（TNFi）治疗的中轴型脊柱关节炎（axSpA）患者治疗反应的影响。
本研究纳入了瑞士临床质量管理队列中符合脊柱关节炎评估协会（ASAS）axSpA分类标准的患者。采用多调整纵向混合效应模型分析吸烟状况与 TNFi 治疗反应（Bath 强直性脊柱炎疾病活动指数（BASDAI）和强直性脊柱炎疾病活动评分（ASDAS））之间的潜在关联。采用多调整逻辑回归分析评估 1 年时的二元应答率。
698 例 axSpA 患者接受了首种 TNFi 治疗，且可获得吸烟状况和基线或随访时 BASDAI 评估结果，其中 490 例（70%）患者具有完整的协变量数据。与不吸烟者相比，基线 C 反应蛋白（CRP）水平升高的患者中，当前吸烟者在接受 TNFi 治疗后 BASDAI 和 ASDAS 评分的降低幅度明显较小（分别减少 0.75 BASDAI 单位和 0.69 ASDAS 单位，p=0.005 和 0.001）。在 CRP 正常的患者中，这种效果的数值较小。与不吸烟者相比，当前吸烟者在 1 年时达到 BASDAI 应答 50%改善或 ASAS 标准 40%改善的可能性显著降低（0.54，95%CI 0.31 至 0.95，p=0.03 和 0.43，95%CI 0.24 至 0.76，p=0.004）。
当前吸烟与 axSpA 患者对 TNFi 的应答受损有关。
