Tobacco smoking negatively influences the achievement of greater than three-quarters reduction in psoriasis area and severity index after eight weeks of treatment among patients with psoriasis: Findings from a prospective study

Yan Qiang; Le Kuai; Shuo Liu; Quanruo Xu; Lingzi Shenfan; Rui Zhang; Zhongzhi Gao; Xiangjin Gao; Bin Li; Ruiping Wang

doi:10.18332/tid/184143

Tobacco smoking negatively influences the achievement of greater than three-quarters reduction in psoriasis area and severity index after eight weeks of treatment among patients with psoriasis: Findings from a prospective study

Tob Induc Dis. 2024 Apr 11:22. doi: 10.18332/tid/184143. eCollection 2024.

Authors

Yan Qiang¹, Le Kuai², Shuo Liu¹, Quanruo Xu³, Lingzi Shenfan³, Rui Zhang¹, Zhongzhi Gao¹, Xiangjin Gao¹, Bin Li¹, Ruiping Wang^{1

3}

Affiliations

¹ Clinical Research Center, Shanghai Skin Diseases Hospital, School of Medicine, Tongji University, Shanghai, China.
² Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
³ School of Public Health, Shanghai University of Traditional Chinese Medicine, Shanghai, China.

Abstract

Introduction: Smoking is an independent and modifiable risk factor for the onset and development of psoriasis; however, evidence on the association between tobacco smoking and psoriasis treatment efficacy is limited. This study aimed to explore the influence of smoking on treatment efficacy in a cohort of patients with psoriasis in Shanghai, China.

Methods: Patients with psoriasis were recruited from the Shanghai Skin Disease Hospital between 2021 and 2022. The treatment for patients with psoriasis includes acitretin, methotrexate, narrow-band ultraviolet/benvitimod, and biologics. Data were collected using a structured questionnaire, physical examination, and disease severity estimation at baseline, week four, and week eight. The achievement of a ≥75% reduction in psoriasis area and severity index (PASI₇₅) score from baseline to week 8 was set as the primary outcome for treatment efficacy estimation. Data were analyzed using SAS 9.4.

Results: A total of 560 patients with psoriasis were enrolled in this study, who were predominantly males (72.9%). The average age of patients was 48.4 years, and 38.8% of them were current smokers, 5.0% of them were former smokers. The median score of PASI among patients changed from 11.1 (interquartile range, IQR: 7.9-16.6) at baseline to 6.2 at week 4 and 3.1 at week 8, and 13.8% and 47.3% of patients with psoriasis achieved PASI₇₅ at weeks 4 and 8, respectively. Logistic regression indicated that patients without tobacco smoking had a higher proportion of PASI₇₅ achievement at week 8. The adjusted odds ratio (AOR) was 11.43 (95% CI: 6.91-18.89), 14.14 (95% CI: 8.27-24.20), and 3.05 (95% CI: 1.20-7.76) for non-smokers compared with smokers, current smokers, and former smokers, respectively. Moreover, former smokers had higher PASI₇₅ achievement than current smokers (AOR=3.37), and patients with younger smoking initiation age, longer smoking duration, and higher smoking intensity had lower PASI₇₅ achievement.

Conclusions: Tobacco smoking was negatively associated with PASI₇₅ achievement both in current and former smokers, and former smokers had higher PASI₇₅ achievement than current smokers. The implementation of tobacco control measures is beneficial for improving treatment responses.

Keywords: psoriasis; psoriasis area severity index (PASI); smoker; treatment efficacy.

Grants and funding

FUNDING This study was supported by the Clinical Research Plan of SHDC (SHDC2022CRS053), the Clinical Research Program of Shanghai Municipal Health Commission (202240371), Hospital Management Program of Shanghai Hospital Association (X2022117), Intelligence Fund of Shanghai Skin Diseases Hospital (2021KYQD01), China Fund for Medical Equipment (LCIIT2022-03), China YMIOO Program (LCIIT2022-09), Shanghai Talent Development Fund (2021073), Shanghai Sailing Program (21YF1448100), Xinglin Youth Scholar of Shanghai University of Traditional Chinese Medicine (RY411.33.10), Youth Talent Promotion Project of China Association of Traditional Chinese Medicine (2021-2023) Category A (CACM-2021-QNRC2-A10), Health Young Talents of Shanghai Municipal Health Commission (2022YQ026), ‘Chen Guang’ project supported by Shanghai Municipal Education Commission and Shanghai Education Development Foundation (22CGA50), and Shanghai Pujiang Talent Program (No. 2020PJD067). The founders had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation.