2227: The Impact of Smoking Status on One Year Secukinumab Retention Rate in 1,684 Patients with PsA: Real-World Results from the EuroSpA Collaboration

Zohra Faizy Ahmadzay¹, Stylianos Georgiadis², Marion Pons², Merete Hetland², Bente Glintborg³, Jette Heberg², Sara Nysom Christiansen², Simon Horskjær Rasmussen², Anne Gitte Loft⁴, Isabel Castrejon⁵, Lucia Otero-Valera⁶, Jakub Zavada⁷, Karel Pavelka⁸, Heikki Relas⁹, Laura Kuusalo¹⁰, Burkhard Moeller¹¹, Michael Nissen¹², Ziga Rotar¹³, Katja Perdan Pirkmajer¹⁴, Daniela Santos Oliveira¹⁵, Ana Rita Cruz-Machado¹⁶, Brigitte Michelsen¹⁷, Eirik Kristianslund¹⁸, Bjorn Gudbjornsson¹⁹, Gerdur Maria Grondal²⁰, Karin Laas²¹, Pasoon Hellamand²², Ismail Sari²³, Daniela Di Giuseppe²⁴, Mikkel Østergaard²⁵ and Lykke Ørnbjerg², ¹Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Denmark, ²Copenhagen Center for Arthritis Research, Rigshospitalet, Copenhagen, Denmark, ³Rigshospitalet Glostrup, University of Copenhagen, Virum, Denmark, ⁴Aarhus University, Horsens, Denmark, ⁵Hospital General Universitario Gregorio Marañón, Madrid, Spain, ⁶Spanish Society of Rheumatology, Madrid, Spain, ⁷Institute of Rheumatology; Charles University, Prague, Czech Republic, ⁸Institut of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Praha, Czech Republic, ⁹Helsinki University Hospital, Helsinki, Finland, ¹⁰Division of Internal Medicine, Centre for Rheumatology and Clinical Immunology, University of Turku and Turku University Hospital, Turku, Finland, ¹¹Inselspital - University Hospital Bern, Bern, Switzerland, ¹²Geneva University Hospitals, Geneva, Switzerland, ¹³University Medical Centre Ljubljana, Ljubljana, Slovenia, ¹⁴Department of Rheumatology, University Medical Centre LJubljana, Ljubljana, Slovenia, ¹⁵Department of Medicine, Faculty of Medicine, University of Porto, Rheumatology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal, ¹⁶Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, CHULN, Academic Medical Center and ERN-ReCONNET; Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa; Reuma.pt Sociedade Portuuesa de Reumatologia, Lisbon, Portugal, ¹⁷Rigshospitalet Glostrup; Diakonhjemmet Hospital; Sørlandet Hospital, Copenhagen, Denmark, ¹⁸Diakonhjemmet Hospital, Oslo, Norway, ¹⁹Centre for Rheumatology Research, University Hospital, Reykjavik, Iceland, ²⁰Department for Rheumatology, Landspitali University Hospital, Reykjavik, Iceland, ²¹Department of Rheumatology, East-Tallinn Central Hospital, Tallinn, Estonia, ²²Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands, ²³Division of Rheumatology, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey, ²⁴Karolinska Institutet, Stockholm, Sweden, ²⁵Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet; University of Copenhagen, Copenhagen, Denmark

Background/Purpose: Smoking has been associated with higher disease activity, poorer treatment response, and drug retention rate among psoriatic arthritis (PsA) patients treated with Tumor Necrosis Factor inhibitors. However, few studies have investigated the impact of smoking on secukinumab (an IL17A inhibitor) treatment outcomes. In this study, we therefore aimed to investigate the association between smoking status and 12-month secukinumab retention rate in patients with PsA treated in routine care.

Methods: Patients with PsA, initiating secukinumab between January 1^st, 2015 and December 31^st, 2020, with available smoking data were identified in 10 European registries participating in the European Spondyloarthritis Research Collaboration Network (EuroSpA RCN). Patients were stratified according to their smoking status (never/former/current) at treatment start (baseline). Kaplan-Meier estimation with log-rank tests and Cox regression with hazard ratios (HR) were performed to assess and compare 12-month secukinumab retention rates. Three regression models were assessed: Model A) unadjusted analyses, Model B) adjusted for baseline age and gender and Model C) further adjusted for registry, time since diagnosis, and line of treatment with biologic/targeted disease-modifying antirheumatic drugs(b/tsDMARD). Missing baseline covariates were imputed using multiple imputation with chained equations.

Results: Of 2,325 patients starting secukinumab treatment, 1,684 had available data on smoking status and were included. At baseline, never smokers compared to former and current smokers were older and scored higher in Disease Activity index for PSoriatic Arthritis in 28 joints (DAPSA28), C-reactive protein (CRP), and Physician Global Assessment, table 1. The 12-month retention rates were 77%, 72% and 71% among never, former, and current smokers, respectively, figure 1. For both former and current smokers, the hazard rates of withdrawal were significantly higher compared to never smokers in unadjusted, and in age and gender-adjusted analyses, figure 2. A similar trend was found in the fully adjusted Model C (HR 1.15 (95% confidence interval 0.90-1.48) and HR 1.18 (0.91-1.53), respectively), figure 2.

Conclusion: In PsA, current and former smokers, who initiate secukinumab treatment appear at increased risk of withdrawing therapy within 12 months as compared to never smokers. Studies of effectiveness should include smoking status, and further studies are needed to investigate if smoking cessation improves treatment outcomes.








Z. Faizy Ahmadzay: Novartis, 5; S. Georgiadis: Novartis, 5; M. Pons: Novartis, 5; M. Hetland: AbbVie/Abbott, 1, 5, Bristol-Myers Squibb(BMS), 5, Danbio, 12, Chari of Danbio registry, Eli Lilly, 5, MEDAC, 6, Novartis, 5, Pfizer, 5, 6, Sandoz, 5, 6; B. Glintborg: AbbVie/Abbott, 5, Bristol-Myers Squibb(BMS), 5, Sandoz, 5; J. Heberg: Novartis, 5; S. Nysom Christiansen: Novartis, 5, 6; S. Horskjær Rasmussen: Novartis, 5; A. Loft: Ucb, 1, 6, 12, Congress participation; I. Castrejon: None; L. Otero-Valera: None; J. Zavada: None; K. Pavelka: Abbvie, 2, 6, Amgen, 2, 6, Bristol-Myers Squibb(BMS), 2, 6, Egis, 2, 6, MSD, 2, 6, Pfizer, 2, 6, Roche, 2, 6, UCB, 2, 6; H. Relas: None; L. Kuusalo: None; B. Moeller: None; M. Nissen: AbbVie/Abbott, 2, Eli Lilly, 2, 12, Involved in Clinical Trial, Janssen, 2, Novartis, 6, 12, research funding paid to institution, Pfizer, 6, UCB, 2, 12, funding support to attend EULAR 2023, paid to institution; Z. Rotar: None; K. Perdan Pirkmajer: None; D. Santos Oliveira: None; A. Cruz-Machado: None; B. Michelsen: Novartis, 5; E. Kristianslund: None; B. Gudbjornsson: Nordic-Pharma, 6, Novartis, 2, 6; G. Grondal: None; K. Laas: None; P. Hellamand: Novartis, 12, Research grant to employer (not to me); I. Sari: None; D. Di Giuseppe: None; M. Østergaard: AbbVie, 2, 5, 6, Amgen, 5, Boehringer-Ingelheim, 2, 6, Bristol-Myers Squibb(BMS), 2, 5, 6, Celgene, 2, 5, 6, Eli Lilly, 2, 6, Galapagos, 2, 6, Gilead, 2, 6, Hospira, 2, 6, Janssen, 2, 6, MEDAC, 6, Merck, 2, 5, 6, Novartis, 2, 5, 6, Novo Nordisk, 2, 6, Orion, 2, 6, Pfizer, 2, 6, Regeneron, 2, 6, Roche, 2, 6, Sandoz, 2, 6, Sanofi, 2, 6, UCB, 2, 6; L. Ørnbjerg: Novartis, 5.