烟草使用对接受富马酸二甲酯或芬戈莫德治疗的多发性硬化症患者疾病活动及疾病修正治疗药物停用的影响
Effect of tobacco use on disease activity and DMT discontinuation in multiple sclerosis patients treated with dimethyl fumarate or fingolimod.
作者信息
Hersh Carrie M, Harris Haleigh, Ayers Malissa, Conway Devon
机构信息
Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, USA.
Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH, USA.
出版信息
Mult Scler J Exp Transl Clin. 2020 Oct 13;6(4):2055217320959815. doi: 10.1177/2055217320959815. eCollection 2020 Oct-Dec.
BACKGROUND
Tobacco exposure is a modifiable risk factor for multiple sclerosis (MS). Studies evaluating the relationship between tobacco, disease activity, and disease modifying therapy (DMT) persistence yielded conflicting results. We sought to address this issue with data from clinical practice.
OBJECTIVE
To compare 24-month disease outcomes in tobacco versus non-tobacco users treated with dimethyl fumarate (DMF) or fingolimod (FTY) in clinical practice.
METHODS
We retrospectively identified 659 MS patients treated with DMF or FTY, stratified by patient-reported tobacco use. DMT discontinuation and measures of disease activity at 24 months were assessed using propensity score (PS) weighting. Outcome estimates were calculated as tobacco vs non-tobacco use.
RESULTS
164 tobacco users (DMF n = 101; FTY n = 63) and 495 non-tobacco users (DMF n = 294; FTY n = 201) were identified. Tobacco (39.4%) and non-tobacco (34.4%) users were equally likely to discontinue DMT (OR = 1.17, 95% CI 0.79, 1.75), but tobacco users discontinued therapy earlier (HR = 1.53, 95% CI 1.06, 2.43). There were no differences in ARR (rate ratio = 1.39, 95% CI 0.97, 1.96). However, tobacco users had decreased odds of NEDA-2 (OR = 0.61, 95% CI 0.44, 0.83).
CONCLUSION
Our findings suggest that tobacco is a negative risk factor for inflammatory disease activity and earlier DMF and FTY discontinuation.
背景
接触烟草是多发性硬化症（MS）的一个可改变的风险因素。评估烟草、疾病活动与疾病修正治疗（DMT）持续性之间关系的研究得出了相互矛盾的结果。我们试图利用临床实践数据来解决这个问题。
目的
比较临床实践中接受富马酸二甲酯（DMF）或芬戈莫德（FTY）治疗的烟草使用者与非烟草使用者的24个月疾病转归。
方法
我们回顾性确定了659例接受DMF或FTY治疗的MS患者，并根据患者报告的烟草使用情况进行分层。使用倾向评分（PS）加权评估DMT停药情况和24个月时的疾病活动度指标。结局估计值按烟草使用者与非烟草使用者进行计算。
结果
确定了164例烟草使用者（DMF组101例；FTY组63例）和495例非烟草使用者（DMF组294例；FTY组201例）。烟草使用者（39.4%）和非烟草使用者（34.4%）停用DMT的可能性相同（OR = 1.17，95%CI 0.79，1.75），但烟草使用者更早停用治疗（HR = 1.53，95%CI 1.06，2.43）。年复发率（ARR）无差异（率比 = 1.39，95%CI 0.97，1.96）。然而，烟草使用者达到无疾病活动状态2（NEDA-2）的几率降低（OR = 0.61，95%CI 0.44，0.83）。
结论
我们的研究结果表明，烟草是炎症性疾病活动以及更早停用DMF和FTY的负面风险因素。
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