Effects of smoking on clinical treatment outcomes amongst patients with chronic inflammatory diseases initiating biologics: secondary analyses of the prospective BELIEVE cohort study

Maja Graves Rosenkilde Larsen, Silja Hvid Overgaard, Sofie Ronja Petersen, Karen Mai Møllegaard, Heidi Lausten Munk, Anders Bathum Nexøe, Henning Glerup, Tanja Guldmann, Natalia Pedersen, Sanaz Saboori, Jens Frederik Dahlerup, Christian Lodberg Hvas, Karina Winther Andersen, Mohamad Jawhara, Ole Haagen Nielsen, Fredrik Olof Bergenheim, Jacob Broder Brodersen, Anette Bygum, Torkell Ellingsen, Jens KjeldsenRobin Christensen, Vibeke Andersen

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Abstract

The prevalence and disease burden of chronic inflammatory diseases (CIDs) are predicted to rise. Patients are commonly treated with biological agents, but the individual treatment responses vary, warranting further research into optimizing treatment strategies. This study aimed to compare the clinical treatment responses in patients with CIDs initiating biologic therapy based on smoking status, a notorious risk factor in CIDs. In this multicentre cohort study including 233 patients with a diagnosis of Crohn's disease, ulcerative colitis, rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis or psoriasis initiating biologic therapy, we compared treatment response rates after 14 to 16 weeks and secondary outcomes between smokers and non-smokers. We evaluated the contrast between groups using logistic regression models: (i) a "crude" model, only adjusted for the CID type, and (ii) an adjusted model (including sex and age). Among the 205 patients eligible for this study, 53 (26%) were smokers. The treatment response rate among smokers (n = 23 [43%]) was lower compared to the non-smoking CID population (n = 92 [61%]), corresponding to a "crude" OR of 0.51 (95% CI: [0.26;1.01]) while adjusting for sex and age resulted in consistent findings: 0.51 [0.26;1.02]. The contrast was apparently most prominent among the 38 RA patients, with significantly lower treatment response rates for smokers in both the "crude" and adjusted models (adjusted OR 0.13, [0.02;0.81]). Despite a significant risk of residual confounding, patients with CIDs (rheumatoid arthritis in particular) should be informed that smoking probably lowers the odds of responding sufficiently to biological therapy. Registration: Clinical.Trials.gov NCT03173144.

Original languageEnglish
Article numbere13395
JournalScandinavian Journal of Immunology
Volume100
Issue number3
Number of pages15
ISSN0301-6323
DOIs
Publication statusPublished - 2024
Externally publishedYes

Bibliographical note

© 2024 The Author(s). Scandinavian Journal of Immunology published by John Wiley & Sons Ltd on behalf of The Scandinavian Foundation for Immunology.

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