Air pollution predicts decreased response to biological treatment in rheumatic diseases

According to a case-crossover study, a poor response to bDMARDs in CIA patients is associated with air pollution; adding to further evidence to its relevance as a factor in rheumatic diseases.

The evidence mounts on the link between air pollution and rheumatic diseases 

A poor response to biological disease-modifying anti-rheumatic drugs (bDMARDs) in patients with chronic inflammatory arthritis (CIA) is associated with environmental air pollution. This was the main result of a case-crossover study among Italian CIA 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 (Italy). Daily air pollution data (2013–2018) of the Verona area and data on CIA patients within this area was examined. Included in the case-crossover analysis were patients who had experienced a stable period of ≥6 months of bDMARD therapy with ≥1 low disease activity (DA) 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.

DA + air pollution were better therapy switch or swap predictors

Air pollution concentrations of the 60-day periods prior to the low DA visit and the flare visit were compared. The results demonstrated that air pollution concentrations were significantly higher prior to the flare visit compared with the low DA visit. In addition, receiving operating characteristics (ROC) curves demonstrated that the combination of DA and air pollution was a better predictor for therapy switch or swap than DA alone.

Dr Giovanni Adami (University of Verona, Italy) emphasized that these results show a direct association between environmental air pollution and a poor response to bDMARDs in CIA 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.” 

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