POS0181-HPR EFFECT OF AN INTENSIVE SMOKING CESSATION INTERVENTION ON SMOKING CESSATION AND DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS: A RANDOMISED CONTROLLED TRIAL
Authors: B. A. Esbensen, T. Thomsen, I. K. Roelsgaard, M. Østergaard, M. Lund Hetland, A. G. Semb, H. Tønnesen, L. Andersen, R. Christensen
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Rheumatoid arthritis (RA) is a chronic, inflammatory rheumatic disease with the potential to induce significant disability. Patients with RA are at increased risk of cardiovascular diseases (CVD). Smokers with RA tend to experience more pain and fatigue, higher disease activity, more erosive joint destruction, and a lower health-related quality of life (HR-QoL) than non-smokers. It remains to be determined whether these effects can be reduced by smoking cessation intervention (SCI). <h3>Objectives:</h3> The primary objective was to compare the effect of an intensive SCI, relative to treatment-as-usual, on smoking cessation and achievement of EULAR clinical response on disease activity 3 months post-intervention, in patients with RA. <h3>Methods:</h3> The randomised 'REU-stop' study was designed as a multicentre, open label, two arm, parallel group, randomised controlled trial, including 150 daily smokers with RA, being in remission or having low-to-moderate disease activity (DAS28 ≤ 5.1) [1]. The intensive SCI consisted of five individual counselling sessions (during 6 weeks) with a smoking cessation counsellor, plus free nicotine replacement therapy. Smoking cessation was self-reported and validated using exhaled carbon monoxide. Patients were followed over 58 weeks from baseline (i.e., 12 months post intervention period), with outcome assessments at 3, 6, and 12, months post intervention. The co-primary endpoints were analysed 3 months post intervention according to the intention-to-treat population, using logistic regression with missing data handled by a simplistic imputation assuming trial failure. <h3>Results:</h3> In total, 94 individuals underwent randomisation, with 49 and 45 patients allocated to smoking cessation and control, respectively. The mean age was 58.4 years (SD 9.9) and 64 (68%) were women. Baseline disease activity score of 28 joints was 2.95 (SD 1.29). At 3 months after the intervention, 9 (18%) intervention and 2 (4%) control patients achieved self-reported smoking cessation (co-primary endpoint), OR=4.84 [95%CI 0.99 to 23.76]) validated by exhaled carbon monoxide. Six (12%) intervention and 9 (20%) control patients had a EULAR clinical response (co-primary endpoint) OR=0.56 [0.18 to 1.72]) (Figure 1). Among the secondary outcomes, DAS28, number of tender joints and CRP improved more in the control group than in the cessation group, while the remaining secondary outcomes did not differ across groups (Table 1). <h3>Conclusion:</h3> In this randomised trial, intensive SCI had no significant effect on the primary co-outcomes (smoking cessation and EULAR clinical response), while three of the secondary core outcomes showed significantly higher disease activity scores compared to the control group. <b>Trial Registration:</b> ClinicalTrials.gov, identifier: NCT02901886. <h3>REFERENCES:</h3> [1] Roelsgaard, I. K., Thomsen, T., Østergaard, M., Christensen, R., Hetland, M. L., Jacobsen, S., Andersen, L., Tønnesen, H., Rollefstad, S., Semb, A. G., &amp; <b>Esbensen, B. A</b>. (2017). The effect of an intensive smoking cessation intervention on disease activity in patients with rheumatoid arthritis: Study protocol for a randomised controlled trial. <i>Trials</i>, <i>18</i>(1). https://doi.org/10.1186/s13063-017-2309-5. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Bente Appel Esbensen: None declared, Thordis Thomsen: None declared, Ida Kristiane Roelsgaard: None declared, Mikkel Østergaard: None declared, Merete Lund Hetland Speaker for Pfizer, Medac, Sandoz (no personal income, institution), Research grants (institution) from Abbvie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V, Lundbeck Fonden, MSD, Medac, Pfizer, Roche, Samsung Biopies, Sandoz, Novartis, Nordforsk, Anne Grete Semb: None declared, Hanne Tønnesen: None declared, Lena Andersen: None declared, Robin Christensen: None declared.