Dr. Curtis has received consultancy fees, speaking fees, and/or honoraria (less than $10,000 each) from Abbott, Bristol-Myers Squibb, Crescendo, and Pfizer, and (more than $10,000 each) from Amgen, Centocor, the Consortium of Rheumatology Researchers of North America, Roche/ Genentech, and UCB.
Serum cotinine as a biomarker of tobacco exposure and the association with treatment response in early rheumatoid arthritis†
Version of Record online: 28 NOV 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis Care & Research
Volume 64, Issue 12, pages 1804–1810, December 2012
How to Cite
Maska, L. B., Sayles, H. R., O'Dell, J. R., Curtis, J. R., Bridges, S. L., Moreland, L. W., Cofield, S. S. and Mikuls, T. R. (2012), Serum cotinine as a biomarker of tobacco exposure and the association with treatment response in early rheumatoid arthritis. Arthritis Care Res, 64: 1804–1810. doi: 10.1002/acr.21758
ClinicalTrials.gov identifier: NCT00259610.
- Issue online: 28 NOV 2012
- Version of Record online: 28 NOV 2012
- Accepted manuscript online: 21 JUN 2012 09:14AM EST
- Manuscript Accepted: 7 JUN 2012
- Manuscript Received: 16 MAR 2012
- Amgen (etanercept and placebo)
- Barr Pharmaceuticals (methotrexate)
- Pharmacia (sulfasalazine and placebo)
- NIH planning grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases
- Arthritis Foundation
- Agency for Healthcare Research and Quality. Grant Number: R01-HS-018517
- NIH. Grant Numbers: AR-053351, R01-AR-052658
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.
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.
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.
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.