Impact of smoking on the effectiveness of TNF-α inhibitors in patients with rheumatoid arthritis or Crohn's disease

Abstract

These authors contributed equally as co-first authorsCigarette smoking may be associated with the augmentation of pro-inflammatory cytokines including Tumor Necrosis Factor-alpha (TNF-α), which may affect the outcomes of pharmacological agents such as TNF-α inhibitors. The purpose of this study was to investigate the impact of smoking on the effectiveness of TNF-α inhibitors in patients with rheumatoid arthritis (RA) or Crohn's disease (CD). We used systematic literature review methods. A total of 1,147 articles were selected after exclusion of duplicates through a database search. Among them, 28 articles were finally selected through a review of titles and abstracts and a subsequent review of full articles. The effectiveness of TNF-α inhibitors in patients with RA or CD among the selected articles was summarized by their smoking status. Meta-analysis was performed with random effect model. When current smokers were compared with non-smokers for response after adjustments through meta-analysis among patients with RA, current smokers had 59% less response than non-smokers with statistical significance (Pooled adjusted OR=0.41, 95% CI=0.17-0.95). In patients with CD, current smokers tended to have lower clinical response than non-smokers, but statistical significance was not shown. In subgroup analyses for luminar CD or fistulizing CD, current smokers tended to have a lower response in luminar CD (Pooled OR=0.62, 95% CI=0.34-1.14), but smoking status was not associated with drug response in fistulizing CD. This study raises awareness of the adverse effects of smoking in terms of clinical response in patients treated with TNF-α inhibitors.

Applications of Lifestyle Medicine in the Management of Hidradenitis Suppurativa: A Literature Review

“…Instead, the diets are characterized by high intakes of fruits, vegetables, lean meats, fish and nuts that have shown to contain antioxidants and fewer prooxidant properties [14,16]. A diet high in antioxidant substances can reduce oxidative stress that has been suggested to induce the production of proinflammatory cytokines (TNF-α) present in HS lesions [14,17]. These cytokines play a key role in the cellular inflammatory processes of other skin conditions such as psoriasis by proliferating keratinocytes and creating epidermal plaques [18].…”

“…This leads to the induction of systemic inflammation and for HS patients, the exacerbation of existing lesions. Consequently, active smokers with HS may experience reduced efficacy of TNFα inhibitor pharmaceutics such as Humira [17,23]. This is similar with another skin condition, psoriasis, wherein tobacco smoking is suggested to exacerbate existing plaques and trigger the onset of the disease in some individuals [24].…”