Distress, smoking influence patients’ continuation of RA treatment

Preexisting psychological distress, such as depression, has a significant effect on whether patients with rheumatoid arthritis (RA) continue or discontinue tumor necrosis factor α (TNF-α) treatment. Limiting cigarette smoking may be beneficial for continuation of TNF-α therapy, and the presence of cardiovascular or cerebrovascular disease at baseline is another factor.

Mattey and coworkers evaluated 166 patients with RA for psychological distress and smoking habits at baseline and periodically over 36 months of TNF-α treatment. Discontinuation of therapy was investigated only in patients who were previously TNF-α inhibitor– or other biologic agent–naive.

Current smokers at baseline were more likely to be anxious or depressed than patients who had never smoked. Measures of psychological distress were more closely associated with the length of time they smoked than with pack years. Close to half the study participants discontinued TNF-α treatment, some because the treatment was ineffective and others because they experienced adverse effects. Discontinuation of therapy was strongly linked with mood disorder, current smoking, smoking more than 30 pack years, and smoking for longer than 30 years.

The authors noted that discontinuation of TNF-α treatment clearly is a complex, multidimensional end point that may be influenced by several biological, emotional, and sociological factors.