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Air pollution predicts decreased response to biological treatment in rheumatic diseases

Presented by
Dr Giovanni Adami, University of Verona, Italy
EULAR 2021
A poor response to biological (b)DMARDs in patients with rheumatic diseases (RMDs) is associated with environmental air pollution. This was the main result of a case-crossover study among Italian RMD patients, and it adds to the increasing evidence that air pollution is a relevant factor in rheumatic diseases.

For this study, data was collected from the registry of biological therapies of the University of Verona. Daily air pollution data (2013–2018) of the Verona area and data on RMD patients within this area were examined. The case-crossover analysis included the patients who had experienced a stable period of ≥6 months of bDMARD therapy with ≥1 low disease activity (LDA) visit plus a treatment switch or swap visit (flare visit) due to drug inefficacy (n=280). Patients who switched or swapped bDMARDs due to adverse events or drug intolerance were excluded from further analysis. Air pollution concentrations of the 60-day periods prior to the LDA visit and the flare visit were compared.

The results demonstrated that the mean concentrations of air pollutants were significantly higher prior to the flare visit compared with the LDA visit (P<0.001). In addition, ROC curves demonstrated that the combination of LDA and air pollution was a better predictor for therapy switch or swap than LDA alone. Dr Giovanni Adami (University of Verona, Italy) emphasised that these results show a direct association between environmental air pollution and a poor response to bDMARDs in RMD patients. “The ROC curves show that air pollution is an independent predictor of response to bDMARDs. When considering 100 bDMARD therapy switches or swaps, approximately 5 of them can be ascribed to the sole effect of air pollution.” This interesting work certainly needs replication in larger cohorts.

  1. Adami G, et al. Air pollution is a predictor of poor response to biological therapies in chronic inflammatory arthritides. POS0644, EULAR 2021 Virtual Congress, 2–5 June.


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