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Patients are commonly treated with biological agents, but the individual treatment responses vary, warranting further research into optimizing treatment strategies. This study aimed to compare the clinical treatment responses in patients with CIDs initiating biologic therapy based on smoking status, a notorious risk factor in CIDs. In this multicentre cohort study including 233 patients with a diagnosis of Crohn's disease, ulcerative colitis, rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis or psoriasis initiating biologic therapy, we compared treatment response rates after 14 to 16\u2009weeks and secondary outcomes between smokers and non\u2010smokers. We evaluated the contrast between groups using logistic regression models: (i) a \u201ccrude\u201d model, only adjusted for the CID type, and (ii) an adjusted model (including sex and age). Among the 205 patients eligible for this study, 53 (26%) were smokers. The treatment response rate among smokers (<jats:italic>n<\/jats:italic>\u2009=\u200923 [43%]) was lower compared to the non\u2010smoking CID population (<jats:italic>n<\/jats:italic>\u2009=\u200992 [61%]), corresponding to a \u201ccrude\u201d OR of 0.51 (95% CI: [0.26;1.01]) while adjusting for sex and age resulted in consistent findings: 0.51 [0.26;1.02]. The contrast was apparently most prominent among the 38 RA patients, with significantly lower treatment response rates for smokers in both the \u201ccrude\u201d and adjusted models (adjusted OR 0.13, [0.02;0.81]). Despite a significant risk of residual confounding, patients with CIDs (rheumatoid arthritis in particular) should be informed that smoking probably lowers the odds of responding sufficiently to biological therapy. Registration: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinical.trials.gov\">Clinical.Trials.gov<\/jats:ext-link> NCT03173144.<\/jats:p>","DOI":"10.1111\/sji.13395","type":"journal-article","created":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T05:24:43Z","timestamp":1720416283000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Effects of smoking on clinical treatment outcomes amongst patients with chronic inflammatory diseases initiating biologics: secondary analyses of the prospective BELIEVE cohort study"],"prefix":"10.1111","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7167-6309","authenticated-orcid":false,"given":"Maja Graves Rosenkilde","family":"Larsen","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Molecular Diagnostics and Clinical Research Unit University Hospital of Southern Denmark  Aabenraa 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