{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T01:59:55Z","timestamp":1785635995919,"version":"3.56.0"},"reference-count":32,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,3,12]],"date-time":"2020-03-12T00:00:00Z","timestamp":1583971200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp;amp; Research"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Observational data facilitate examination of treatment\u2010effect heterogeneity, but the risk of bias is substantial. The present study was undertaken to highlight methodologic considerations through an analysis of whether smoking affects response to tumor necrosis factor inhibitors (<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>i) in axial spondyloarthritis (SpA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used longitudinal data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis. Participants fulfilling the Assessment of SpondyloArthritis international Society criteria for axial SpA who started their first <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>i were eligible for analysis. In comparing the impact of smoking status, weighted generalized estimating equations were used to examine changes in several continuous outcome measures, including the Bath Ankylosing Spondylitis Disease Activity Index (<jats:styled-content style=\"fixed-case\">BASDAI<\/jats:styled-content>) and the Ankylosing Spondylitis Disease Activity Score (<jats:styled-content style=\"fixed-case\">ASDAS<\/jats:styled-content>). Inverse probability weights were used to account for differences in baseline covariates and excluded participants. We separately assessed response in the first 3 months to account for nonrandom dropout.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For 840 participants who started on <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>i, 1,641 assessments from 627 individuals were analyzed (69% male, mean age 46 years). A total of 33% were current smokers and 30% ex\u2010smokers. Ex\u2010smokers and current smokers had worse disease than never smokers at baseline. Accounting for these differences, response did not differ according to smoking status. Compared to never smokers, ex\u2010smokers (\u03b2 = \u20130.6, 95% confidence interval [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] \u20131.4, 0.3) and current smokers (\u03b2 = \u20130.4, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u20131.1, 0.4) had a similar response according to the <jats:styled-content style=\"fixed-case\">BASDAI<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">ASDAS<\/jats:styled-content> (ex\u2010smokers \u03b2 = \u20130.1, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u20130.5, 0.3; current smokers \u03b2 = \u20130.01, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u20130.4, 0.4) at 3 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>i response did not differ according to baseline smoking status in this <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content> cohort. Conflicting results from previous studies were likely due to methodologic differences. This analysis highlights potential sources of bias that should be addressed in future studies.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23851","type":"journal-article","created":{"date-parts":[[2019,2,14]],"date-time":"2019-02-14T08:46:48Z","timestamp":1550134008000},"page":"591-599","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Impact of Smoking in Response to Tumor Necrosis Factor Inhibitors in Axial Spondyloarthritis: Methodologic Considerations for Longitudinal Observational Studies"],"prefix":"10.1002","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3558-7353","authenticated-orcid":false,"given":"Sizheng Steven","family":"Zhao","sequence":"first","affiliation":[{"name":"University of Liverpool and Aintree University Hospital, Liverpool, UK, and Brigham and Women\u2019s Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuki","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital and Harvard T. 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Chan School of Public Health  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gareth T.","family":"Jones","sequence":"additional","affiliation":[{"name":"University of Aberdeen  Aberdeen UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Hughes","sequence":"additional","affiliation":[{"name":"University of Liverpool  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara K.","family":"Tedeschi","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houchen","family":"Lyu","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, and General Hospital of Chinese PLA  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Moots","sequence":"additional","affiliation":[{"name":"University of Liverpool and Aintree University Hospital  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel H.","family":"Solomon","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital and Harvard Medical School  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0714-3568","authenticated-orcid":false,"given":"Nicola J.","family":"Goodson","sequence":"additional","affiliation":[{"name":"University of Liverpool and Aintree University Hospital  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kep422"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.124446"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keu314"},{"key":"e_1_2_7_5_1","first-page":"S1129","article-title":"Smoking is not associated with response to TNF blockers in patients with axial spondyloarthritis","volume":"66","author":"Dellyes A","year":"2014","journal-title":"Arthritis Rheumatol"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-eular.887"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-205133"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kev392"},{"key":"e_1_2_7_9_1","unstructured":"National Institute for Health and Care Excellence.TNF\u2010alpha inhibitors for ankylosing spondylitis and non\u2010radiographic axial spondyloarthritis. 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