Serum cotinine as a biomarker of tobacco exposure and the association with treatment response in early rheumatoid arthritis

Leann B. Maska, Harlan R. Sayles, James Robert O'Dell, Jeffrey R. Curtis, S. Louis Bridges, Larry W. Moreland, Stacey S. Cofield, Ted R Mikuls

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective Cigarette smoking has emerged as a risk factor for the development of rheumatoid arthritis (RA). Recent studies have suggested that cigarette smoking may lead to lower treatment response rates with methotrexate (MTX) and some biologic agents in RA. Knowledge of whether tobacco exposure reduces treatment efficacy is important, since smoking could represent a modifiable factor in optimizing RA treatment. Methods The study participants included patients with early RA (<3 years in duration) enrolled in the Treatment of Early Aggressive Rheumatoid Arthritis study, a randomized, blinded, placebo-controlled clinical trial comparing early intensive therapy (MTX + etanercept or MTX + hydroxychloroquine + sulfasalazine triple therapy) versus initial treatment with MTX with step-up to MTX + etanercept or to triple therapy if the disease was still active at 24 weeks. Serum cotinine was measured using a commercially available enzyme-linked immunosorbent assay at baseline and at 48 weeks, with detectable concentrations at both visits serving as an indicator of smoking status. The mean Disease Activity Score in 28 joints (DAS28) was compared by smoking status, adjusting for baseline disease activity. Results Of the 412 subjects included in the analysis, 293 (71%) were categorized as nonsmokers and 119 (29%) as current smokers. There were no differences in the mean DAS28 score between 48 and 102 weeks based on smoking status for the overall group (P = 0.881) or by specific treatment assignment. Conclusion Among patients enrolled in a large randomized controlled trial of early RA with poor prognostic factors, smoking status did not impact treatment responses for those receiving early combination or initial MTX with step-up therapy at 24 weeks if the disease was still active.

Original languageEnglish (US)
Pages (from-to)1804-1810
Number of pages7
JournalArthritis Care and Research
Volume64
Issue number12
DOIs
StatePublished - Dec 1 2012

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Cotinine
Tobacco
Rheumatoid Arthritis
Biomarkers
Methotrexate
Smoking
Serum
Therapeutics
Joints
Hydroxychloroquine
Sulfasalazine
Controlled Clinical Trials
Biological Factors
Secondary Prevention
Randomized Controlled Trials
Enzyme-Linked Immunosorbent Assay
Placebos

ASJC Scopus subject areas

  • Rheumatology

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Serum cotinine as a biomarker of tobacco exposure and the association with treatment response in early rheumatoid arthritis. / Maska, Leann B.; Sayles, Harlan R.; O'Dell, James Robert; Curtis, Jeffrey R.; Bridges, S. Louis; Moreland, Larry W.; Cofield, Stacey S.; Mikuls, Ted R.

In: Arthritis Care and Research, Vol. 64, No. 12, 01.12.2012, p. 1804-1810.

Research output: Contribution to journalArticle

Maska, Leann B. ; Sayles, Harlan R. ; O'Dell, James Robert ; Curtis, Jeffrey R. ; Bridges, S. Louis ; Moreland, Larry W. ; Cofield, Stacey S. ; Mikuls, Ted R. / Serum cotinine as a biomarker of tobacco exposure and the association with treatment response in early rheumatoid arthritis. In: Arthritis Care and Research. 2012 ; Vol. 64, No. 12. pp. 1804-1810.
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abstract = "Objective Cigarette smoking has emerged as a risk factor for the development of rheumatoid arthritis (RA). Recent studies have suggested that cigarette smoking may lead to lower treatment response rates with methotrexate (MTX) and some biologic agents in RA. Knowledge of whether tobacco exposure reduces treatment efficacy is important, since smoking could represent a modifiable factor in optimizing RA treatment. Methods The study participants included patients with early RA (<3 years in duration) enrolled in the Treatment of Early Aggressive Rheumatoid Arthritis study, a randomized, blinded, placebo-controlled clinical trial comparing early intensive therapy (MTX + etanercept or MTX + hydroxychloroquine + sulfasalazine triple therapy) versus initial treatment with MTX with step-up to MTX + etanercept or to triple therapy if the disease was still active at 24 weeks. Serum cotinine was measured using a commercially available enzyme-linked immunosorbent assay at baseline and at 48 weeks, with detectable concentrations at both visits serving as an indicator of smoking status. The mean Disease Activity Score in 28 joints (DAS28) was compared by smoking status, adjusting for baseline disease activity. Results Of the 412 subjects included in the analysis, 293 (71{\%}) were categorized as nonsmokers and 119 (29{\%}) as current smokers. There were no differences in the mean DAS28 score between 48 and 102 weeks based on smoking status for the overall group (P = 0.881) or by specific treatment assignment. Conclusion Among patients enrolled in a large randomized controlled trial of early RA with poor prognostic factors, smoking status did not impact treatment responses for those receiving early combination or initial MTX with step-up therapy at 24 weeks if the disease was still active.",
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N2 - Objective Cigarette smoking has emerged as a risk factor for the development of rheumatoid arthritis (RA). Recent studies have suggested that cigarette smoking may lead to lower treatment response rates with methotrexate (MTX) and some biologic agents in RA. Knowledge of whether tobacco exposure reduces treatment efficacy is important, since smoking could represent a modifiable factor in optimizing RA treatment. Methods The study participants included patients with early RA (<3 years in duration) enrolled in the Treatment of Early Aggressive Rheumatoid Arthritis study, a randomized, blinded, placebo-controlled clinical trial comparing early intensive therapy (MTX + etanercept or MTX + hydroxychloroquine + sulfasalazine triple therapy) versus initial treatment with MTX with step-up to MTX + etanercept or to triple therapy if the disease was still active at 24 weeks. Serum cotinine was measured using a commercially available enzyme-linked immunosorbent assay at baseline and at 48 weeks, with detectable concentrations at both visits serving as an indicator of smoking status. The mean Disease Activity Score in 28 joints (DAS28) was compared by smoking status, adjusting for baseline disease activity. Results Of the 412 subjects included in the analysis, 293 (71%) were categorized as nonsmokers and 119 (29%) as current smokers. There were no differences in the mean DAS28 score between 48 and 102 weeks based on smoking status for the overall group (P = 0.881) or by specific treatment assignment. Conclusion Among patients enrolled in a large randomized controlled trial of early RA with poor prognostic factors, smoking status did not impact treatment responses for those receiving early combination or initial MTX with step-up therapy at 24 weeks if the disease was still active.

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