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Influence of smoking and obesity on treatment response in patients with axial spondyloarthritis: a systematic literature review

Abstract

To assess whether smoking and obesity are predictors of poor treatment response in patients with axial spondyloarthritis (axSpA). A systematic literature review was performed by searching in MEDLINE and EMBASE up to June 2019 with a strategy based on the PICO approach: Population: patients with axSpA; Intervention or exposure: smoking or obesity; Comparison: non-smokers (for smoking) and normal-weight individuals (for obesity); and Outcome: any response criteria currently validated for axSpA. The 2009 Oxford Centre for Evidence-based Medicine levels were used for assessing the studies quality. Out of 1873 references retrieved, 46 studies were selected for full-text review and 12 for data extraction: six stratified patients by smoking and six by obesity. All were longitudinal observational studies, except one, which was cross-sectional. Overall, these studies included 5291 patients (3917 for smoking and 1333 for obesity), and all these patients were on anti-tumor necrosis factor (anti-TNF) therapy. The quality of evidence was graded as level 2b except that from the cross-sectional study which was graded level 4. For smoking, the evidence found is inconsistent: two studies finding negative effects in response to anti-TNF while the other four found no differences in clinical response to this therapy. Regarding obesity, the evidence is more consistent: five of the six studies describing a negative influence in response to anti-TNF. According to the scientific evidence in patients with axSpA, obesity is associated with a more unsatisfactory response to anti-TNF therapy. A poorer response in smokers has yet to be demonstrated.

Key Points
• Identifying predictors of treatment response in axSpA, especially those that are modifiable, is relevant.
• Obesity increases the risk of poorer response to anti-TNF agents in patients with axSpA.
• Scientific evidence for smoking habit as a predictor of treatment response in axSpA is inconclusive.

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Acknowledgments

The authors would like to thank the Spanish Society of Rheumatology for editing the manuscript.

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Correspondence to Pablo Antonio Zurita Prada.

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Conflict of interest

PZP: Consultancy or grants from Roche, Pfizer, Lylly, and Novartis outside the submitted work

CUL: Grants from Pfizer, Lylly, and Novartis

CGA: Speaker for Janssen, Novartis, Roche, Pfizer, Abbvie, Menarini, Gebro, and GrünenthalScientific consulting for Janssen, Novartis, Gebro, and Grünenthal. Research grants and funding from Janssen, Novartis, and Pfizer

SKC: No conflict of interest

VNC: Grants or personal fees from Abbvie, Lilly, MSD, Novartis, Pfizer, UCM outside the submitted work

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Zurita Prada, P.A., Urrego Laurín, C.L., Guillén Astete, C.A. et al. Influence of smoking and obesity on treatment response in patients with axial spondyloarthritis: a systematic literature review. Clin Rheumatol 40, 1673–1686 (2021). https://doi.org/10.1007/s10067-020-05319-6

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Keywords

  • Ankylosing spondylitis
  • Axial spondyloarthritis
  • Body mass index
  • Clinical response
  • Efficacy
  • Obesity
  • Outcome
  • Overweight
  • Predictors
  • Tobacco