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

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J Rheumatol. 2009 Jun;36(6):1180-7. Epub 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.

Staffordshire Rheumatology Centre, University Hospital of North

Staffordshire, and Institute of Science and Technology in Medicine,

Keele University, Keele, Staffordshire, UK.

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

Not an MD

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Can anyone tell me why I'm not getting 's original posts??

Thx -- in Sc

Sent from my iPhone

On Jan 29, 2010, at 6:07 PM, marysue <marysue@...> wrote:

I am certainly an exception to this finding. I was a very heavy

smoker, had smoked for 34 years and was up to at least three packs a

day. But I have a wonderful response to Enbrel, which of course is one

of the TNF antagonists. I am very lucky!

Sue

On Jan 29, 2010, at 5:27 PM, wrote:

>

> 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.