RESEARCH - Relationship between pack-year history of smoking and response to TNF antagonists in patients with RA

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J Rheumatol. 2009 May 15.

Relationship Between Pack-year History of Smoking and Response to

Tumor Necrosis Factor Antagonists in Patients with Rheumatoid

Arthritis.

Mattey DL, Brownfield A, Dawes PT.

From the Staffordshire Rheumatology Centre, University Hospital of

North Staffordshire; and Institute of Science and Technology in

Medicine, Keele University, Keele, Staffordshire, England.

OBJECTIVE: To determine whether there is a quantitative relationship

between smoking history and response to therapy with tumor necrosis

factor (TNF) antagonists.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

PMID: 19447930

http://www.ncbi.nlm.nih.gov/pubmed/19447930

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