A MAJOR new study spanning 14 European countries suggests that lifestyle factors—particularly smoking and obesity—may significantly reduce the effectiveness of TNF inhibitors in patients with axial spondyloarthritis (axSpA).
The study analysed data from 14,885 biologic-naïve adults beginning their first TNFi therapy. Researchers assessed the impact of smoking, body mass index (BMI), and alcohol use on treatment response at 3 and 12 months, using established outcome measures such as BASDAI-50, ASDAS, and ASAS criteria.
At 12 months, smokers were notably less likely to achieve a BASDAI-50 response than non-smokers (adjusted OR: 0.77; 95% CI: 0.68–0.86). Similarly, treatment response was significantly lower among overweight (OR: 0.76) and obese patients (OR: 0.53) compared to those with a normal BMI. These patterns were consistent across multiple response criteria and after adjusting for baseline disease activity, demographics, and treatment year.
Surprisingly, alcohol consumption was associated with improved treatment outcomes (OR: 1.47; 95% CI: 1.16–1.87). However, the authors caution that this association is unlikely to be causal and may reflect unmeasured confounding factors such as socioeconomic status or physical activity.
“This study highlights modifiable factors that can influence biologic treatment response in axSpA,” the authors write. “Addressing smoking and obesity at therapy initiation could enhance treatment outcomes.”
The findings reinforce the need for a multidisciplinary approach when initiating TNFi therapy in axSpA—one that includes referrals for smoking cessation and weight management support. While the alcohol finding remains intriguing, further research is needed to understand the mechanism behind the association.
This research underscores that lifestyle matters—not just for disease risk, but also for how well treatments work.
Reference
Jones GT et al. The relationship between lifestyle factors and outcome of treatment with TNFα inhibitors in axial spondyloarthritis – results from 14 European countries. BMC Rheumatol. 2025;DOI: 10.1186/s41927-025-00529-4.
