Acta Dermato-Venereologica 99-10CompleteContent | Page 10
CLINICAL REPORT
871
Smoking does not Alter the Therapy Response to Systemic Anti-
psoriatic Therapies: A Two-country, Multi-centre, Prospective,
Non-interventional Study
Florian ANZENGRUBER 1,2 , Matthias AUGUSTIN 3 , Marc A. RADTKE 4 , Diamant THACI 5 , Nikhil YAWALKAR 6 , Markus STREIT 7 ,
Kristian REICH 8 , Mathias DRACH 1,2 , Christina SORBE 3 , Lars E. FRENCH 1,2 , Ulrich MROWIETZ 9 , Julia-Tatjana MAUL 1,2 , Peter
ITIN 10 , and Alexander A. NAVARINI 1,2 ; for the investigators of PsoBest and SDNTT
1
Department of Dermatology, University Hospital Zurich, 2 Faculty of Medicine, University of Zurich, Zurich, Switzerland, 3 Department of
Dermatology, German Center for Health Services Research in Dermatology (CVderm), University Clinics of Hamburg, 4 Institute for Health
Services Research in Dermatology and Nursing, University Medical Center of Hamburg-Eppendorf, Hamburg, 5 Comprehensive Center for
Inflammation Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany, 6 Department of Dermatology, Inselspital, Bern University
Hospital, University of Bern, Bern, 7 Department of Dermatology, Kantonsspital Aarau, Aarau, Switzerland, 8 Dermatologikum Hamburg,
Hamburg, 9 Psoriasis Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany, and
10
Department of Dermatology, University Hospital Basel, Basel, Switzerland
Psoriasis can involve the skin, joints, nails and cardio-
vascular system and result in a significant impairment
in quality of life. Studies have shown a lower response
rate to systemic anti-sporiatic therapies in smokers,
and smoking is a trigger factor for psoriasis. The aim
of this study was therefore to analyse the response to
systemic therapies for psoriasis, with a focus on smo-
king. Prospectively collected data from patients with
moderate to severe psoriasis included in the national
psoriasis registries for Germany and Switzerland (Pso-
Best and SDNTT) were analysed. Therapy response was
defined as reaching a Psoriasis Area and Severity Index
(PASI) reduction of 75%, PASI ≤ 3 or Dermatology Life
Quality Index (DLQI) ≤ 1. Out of 5,346 patients inclu-
ded in these registries, 1,264 met the inclusion crite-
ria for this study. In the smoking group, 715 (60.6%)
reached therapy response at month 3, compared with
358 (63.7%) in the non-smoking group (p ≤ 0.269),
659 (74.1%) vs. 330 (77%) reached therapy respon-
se at month 6 (p ≤ 0.097), and 504 (76.6%) vs. 272
(79.0%) at month 12 (p ≤ 0.611). Therefore, these data
do not show that smoking affects the response rate of
anti-psoriatic therapy after 3, 6 and 12 months.
Key words: tobacco; nicotine; psoriasis; fumaric acid esters;
methotrexate; acitretin; ciclosporin; apremilast; adalimumab;
etanercept; infliximab; ustekinumab; secukinumab; treatment
response.
Accepted May 16, 2019; E-published May 17, 2019
Acta Derm Venereol 2019; 99: 871–877.
Corr: Alexander Navarini, Department of Dermatology, University Hospi-
tal Zurich, Gloriastrasse 31, CH-8091 Zurich, Switzerland. E-mail: alex-
[email protected]
S
moking has been reported as a trigger factor for
psoriasis (1) and smokers are at higher risk than non-
smokers of developing psoriasis (2). Among patients with
psoriasis, the prevalence of cigarette smoking exceeds
that of the general public (odds ratio (OR) 1.78) (2–5).
Besides genetic factors, cigarette smoking and exposure
to tobacco smoke in early childhood are associated with
psoriasis, as shown in a retrospective study (6).
SIGNIFICANCE
The German (PsoBest) and Swiss (SDNTT) Psoriasis Regist-
ries collect data on the efficacy of anti-psoriatic treatments
among smokers and non-smokers. Out of 5,346 patients
included in these registries, 1,264 met the inclusion cri-
teria for this study. In the smoking group, 715 (60.6%)
reached therapy response at month 3, compared with
358 (63.7%) in the non-smoking group. At month 6, 659
(74.1%) vs. 330 (77%), and at month 12, 504 (76.6%) vs.
272 (79.0%) reached therapy response. Therefore, these
data do not show that smoking affects the response rate of
anti-psoriatic therapy after 3, 6 and 12 months.
Triggering the onset of psoriasis can be mediated by
genetic, inflammatory, or oxidative mechanisms (7).
Smoking induces an elevated level of free radicals and
thus causes oxidative damage (8). Several signalling
pathways can be stimulated by tobacco use. Released
cytokines activate T lymphocytes, which cause chronic
inflammation (7). In addition, other triggering factors,
such as obesity, oxidative stress and even insulin-
resistance, are aggravated by tobacco consumption (9).
Both smoking and increased fat mass are associated with
increased serum tumour necrosis factor (TNF)-α levels
(10, 11). Furthermore, due to the persistent inflammation,
the risk of cardiovascular events is increased (12). Psoria-
sis can involve the skin, joints, nails and cardiovascular
system, and causes a significant impairment in quality
of life amongst patients and cohabitants (13).
Several studies have investigated the overall effects of
psoriasis on patient’s health, as well as the overall effi-
cacy of treatment. The causality of smoking and negative
influence on health is better established in diseases other
than psoriasis. In rheumatoid arthritis, negative associa-
tions have been shown between smoking and treatment
response (14) and continuation of TNF blockers (15,
16). Worse responses have been shown for methotrexate
(MTX) treatment (17). It could therefore be assumed that
increased TNF-α due to smoking aggravates psoriasis and
impairs treatment response. This has been investigated
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2019 Acta Dermato-Venereologica.
doi: 10.2340/00015555-3221
Acta Derm Venereol 2019; 99: 871–877