The impact of smoking and obesity on secukinumab effectiveness in psoriatic arthritis: real-world evidence from 1202 European patients

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Objectives: In patients with psoriatic arthritis (PsA) initiating treatment with secukinumab, we investigated the impact of smoking and body mass index (BMI) on secukinumab retention rate at 12 months and the achievement of low Disease Activity Index for PsA in 28 joints (DAPSA28 ≤14) at 6 months. Methods: Patients with PsA initiating secukinumab with available data on smoking and BMI were included. Patients were categorised according to smoking status (never/former/current) and BMI (normal/overweight/obese) at treatment start. Kaplan-Meier curves and adjusted Cox and logistic regression analyses were performed to compare secukinumab retention and response rates, respectively. Additional regression analyses were performed with BMI as a continuous variable. Results: We included 1202 patients. Retention rates in never/former/current smokers were 79%/73%/72% and in normal/overweight/obese 72%/77%/77%, respectively. Adjusted hazard ratios for treatment withdrawal were numerically higher in former (1.32; 95 % CI 1.00-1.75) and current smokers (1.27; 0.93-1.74), while remaining roughly similar across BMI (overweight: 0.90; 0.67-1.21, obese: 0.89; 0.66-1.21, per BMI unit: 1.00; 0.97-1.02). Response rates in never/former/current smokers were 56%/61%/49% and in normal/overweight/obese 57%/59%/52%, respectively. Adjusted odds ratio for achieving low DAPSA28 was numerically lower for current smokers (0.74; 0.47-1.15) but higher for former smokers (1.30; 0.87-1.94), whereas it was numerically lower in patients with obesity (0.74; 0.49-1.11) and lower with each increase in BMI unit (0.97; 0.94-1.00). Conclusions: In real-world patients with PsA, secukinumab retention tended to be lower in current and former smokers. No clear association between BMI and secukinumab effectiveness was observed.

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