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The relationship between lifestyle factors and outcome of treatment with TNFα inhibitors in axial spondyloarthritis – results from 14 European countries

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Title: The relationship between lifestyle factors and outcome of treatment with TNFα inhibitors in axial spondyloarthritis – results from 14 European countries
Authors: Jones, Gareth T., Rotariu, Ovidiu, MacDonald, Ross, Michelsen, Brigitte, Glintborg, Bente, van der Horst-Bruinsma, Irene, Gudbjornsson, Bjorn, Geirsson, Arni Jon, Relas, Heikki, Isomäki, Pia, Závada, Jakub, Pavelka, Karel, Rotar, Ziga, Tomšič, Matija, Nissen, Michael J., Ciurea, Adrian, Codreanu, Catalin, Wallman, Johan K., Kristianslund, Eirik Klami, Rasmussen, Simon Horskjaer, Ørnbjerg, Lykke Midtbøll, Santos, Maria José, Østergaard, Mikkel, Hetland, Merete Lund, Macfarlane, Gary J.
Contributors: Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section III, Rheumatology, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion III, Reumatologi och molekylär skelettbiologi, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section III, Rheumatology, Lund Arthritis Research Group (LARG), Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion III, Reumatologi och molekylär skelettbiologi, Lund Arthritis Research Group (LARG), Originator
Source: BMC Rheumatology. 9(1)
Subject Terms: Medical and Health Sciences, Health Sciences, Drug Abuse and Addiction, Medicin och hälsovetenskap, Hälsovetenskap, Beroendelära och missbruk
Description: Objectives: To quantify the influence of lifestyle factors on tumour necrosis factor inhibitor (TNFi) treatment response, in axial spondyloarthritis (axSpA). Methods: Data on biologics-naïve adults with axSpA were captured from European rheumatology registries. Information on lifestyle factors (smoking, overweight/obesity, and/or alcohol consumption) were identified ± 30 days of commencing their first TNFi. Treatment response (BASDAI-50, ASDAS or ASAS response criteria) was determined at 3 and 12 months. In separate models, the relationship between treatment response and baseline smoking, BMI and alcohol was assessed using logistic regression, adjusted for age, sex, country, calendar year of treatment initiation, disease duration and baseline disease activity. Results: From 14 registries, 14,885 patients were included. Of those with available data, 29% were current smokers, 49% current drinkers, 37% were overweight and 21% were obese. At 12 months, smokers were less likely to achieve BASDAI-50 treatment response compared to non-smokers (adjusted odds ratio: 0.77; 95%CI: 0.68–0.86). A similar effect was observed among overweight (0.76; 0.66–0.87) or obese patients (0.53; 0.45–0.63). In contrast, alcohol drinkers experienced a seemingly beneficial effect (1.47; 1.16–1.87). These associations were also observed with other measures of treatment response and were robust to further adjustment for clinical characteristics. Conclusion: Smoking and high BMI decrease the odds of bDMARD treatment success in axSpA. Rheumatologists should consider referral to smoking cessation and/or weight management interventions at the time of commencing therapy, to enhance treatment response. The relationship between alcohol and treatment response is unlikely to be causal and warrants further investigation.
Access URL: https://doi.org/10.1186/s41927-025-00529-4
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  Data: The relationship between lifestyle factors and outcome of treatment with TNFα inhibitors in axial spondyloarthritis – results from 14 European countries
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  Data: Objectives: To quantify the influence of lifestyle factors on tumour necrosis factor inhibitor (TNFi) treatment response, in axial spondyloarthritis (axSpA). Methods: Data on biologics-naïve adults with axSpA were captured from European rheumatology registries. Information on lifestyle factors (smoking, overweight/obesity, and/or alcohol consumption) were identified ± 30 days of commencing their first TNFi. Treatment response (BASDAI-50, ASDAS or ASAS response criteria) was determined at 3 and 12 months. In separate models, the relationship between treatment response and baseline smoking, BMI and alcohol was assessed using logistic regression, adjusted for age, sex, country, calendar year of treatment initiation, disease duration and baseline disease activity. Results: From 14 registries, 14,885 patients were included. Of those with available data, 29% were current smokers, 49% current drinkers, 37% were overweight and 21% were obese. At 12 months, smokers were less likely to achieve BASDAI-50 treatment response compared to non-smokers (adjusted odds ratio: 0.77; 95%CI: 0.68–0.86). A similar effect was observed among overweight (0.76; 0.66–0.87) or obese patients (0.53; 0.45–0.63). In contrast, alcohol drinkers experienced a seemingly beneficial effect (1.47; 1.16–1.87). These associations were also observed with other measures of treatment response and were robust to further adjustment for clinical characteristics. Conclusion: Smoking and high BMI decrease the odds of bDMARD treatment success in axSpA. Rheumatologists should consider referral to smoking cessation and/or weight management interventions at the time of commencing therapy, to enhance treatment response. The relationship between alcohol and treatment response is unlikely to be causal and warrants further investigation.
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