Letter: biologics are effective in neutralising the detrimental effect of smoking on the natural course of Crohn's disease

Savarino, Edoardo; Bodini, Giorgia; Savarino, Vincenzo

doi:10.1111/apt.13605

Cited by 2 publications

(4 citation statements)

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“…In addition, it has been suggested that smokers have reduced response to anti-tumor necrosis factor (TNF) therapy and may have lower concentrations of the drug in their blood when compared to nonsmokers [7][8][9][10][11][12] and that smokers have higher levels of anti-TNF antibodies than nonsmokers [7]. This association between smoking and clinical outcomes and response to biologic therapy has, however, been recently challenged, and several studies have shown little or no effect of smoking on disease outcomes or response to treatment in the era of biologics [13][14][15]. Indeed, a large multicenter study has confirmed this notion that smoking status has a limited effect on the prevalence of perianal disease and need for surgery in patients with CD [16].…”

Section: Introductionmentioning

confidence: 99%

“…However, the results of this study were not replicable when the analysis was performed on a larger population by the same research group [17] . Therefore, whether, as has been suggested, the use of biologics neutralizes the detrimental effect on the natural course of CD [15] , remains unanswered, mainly because of the paucity of studies that have specifically looked at the timing and type of CD-related surgeries in relationship to tobacco use (current, former, or never) and biologic exposure. This retrospective study aims to investigate the relationship between smoking and the course of disease in CD patients who received biologic therapy at a tertiary care medical center in Lebanon.…”

Section: Introductionmentioning

confidence: 99%

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Smoking Is Not an Independent Risk Factor for Surgery in Patients with Crohn’s Disease on Biologic Therapy

Halablab¹,

Alrazim²,

Sadaka³

et al. 2023

Inflamm Intest Dis

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Introduction: The development and course of inflammatory bowel disease (IBD) appears to be influenced by environmental factors. Particularly, smoking has been shown to assume a harmful role in Crohn’s disease (CD) and a protective role in ulcerative colitis (UC). This study aims to examine the effect of smoking on need for surgery in patients with moderate to severe Crohn’s disease (CD) receiving biologic therapy. Methods: Retrospective study of adult patients with CD at a University Medical Center over a 20-year period. Results: A total of 251 patients were included (mean age 36.0 ± 15.0; 70.1% males; current, former, and non-smokers: 44.2%,11.6%, and 43.8%, respectively). Mean duration on biologics was 5.0 ± 3.1 years (>2/3 received anti-TNFs, followed by ustekinumab in 25.9%) and a third of patients (29.5%) received more than one biologic. Disease-related surgeries (abdominal, perianal or both) occurred in 97 patients (38.6%): 50 patients had surgeries prior to starting biologics only, 41 had some surgeries after, and 6 had insufficient information. There was no significant difference in surgeries between ever-smokers (current or previous) vs. non-smokers in the overall study group. On logistic regression, the odds of having any CD surgery were higher in patients with longer disease duration (OR = 1.05, 95% CI = 1.01, 1.09) and in those receiving more than one biologic (OR = 2.31, 95% CI = 1.16, 4.59). However, among patients who had surgery prior to biologic therapy, smokers were more likely to have perianal surgery compared to non-smokers (OR = 10.6, 95% CI = 2.0, 57.4; p=0.006). Conclusion: In biologic-naive CD patients requiring surgery, smoking is an independent predictor of perianal surgery. Smoking, however, is not an independent risk factor for surgery in this cohort after starting biologics. The risk of surgery in those patients is primarily associated with disease duration and the use of more than one biologic.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Smoking Is Not an Independent Risk Factor for Surgery in Patients with Crohn’s Disease on Biologic Therapy

Halablab¹,

Alrazim²,

Sadaka³

et al. 2023

Inflamm Intest Dis

View full text Add to dashboard Cite

show abstract

“…It is known that IBD was associated with poor outcomes of patients with PSC. 2 However, in the report by Yanai et al, 3…”

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confidence: 96%

“…SIRS, We thank Savarino et al for taking the time to read our paper, 1 and for their comments. 2 We agree that antitumour necrosis factor-a drugs are effective in Crohn's disease, 3 but it is important to remember that these drugs may have serious side effects. 4,5 In addition, as we stated in our paper, 1 although the studies we included were not randomised, using these data to calculate a number needed to treat (NNT) suggested that only seven people with Crohn's disease would need to stop smoking to prevent one flare of disease activity, and 10 would need to stop smoking to prevent one person undergoing a second operation.…”

mentioning

confidence: 99%