Patients with ulcerative colitis who smoke or have never smoked experience similar outcomes in terms of therapies they use, hospitalization and surgery, according to study results.
Additionally, patients who smoke and then quit do not experience worse disease-related outcomes.
Jonathan Blackwell, BMBS, of the department of gastroenterology at St. George’s Healthcare NHS Trust and St. George’s University in London, and colleagues wrote that exposure to smoking can reduce the risk for developing UC by about half, but the relationship between smoking status at diagnosis and disease course remains unclear.
“This has led to a belief that smoking may be beneficial in UC, and some patients report that they smoke to ameliorate their disease,” they wrote. “We sought to confirm or refute the hypothesis that smoking at diagnosis amongst patients with UC is associated with a more benign disease course and that subsequent smoking cessation leads to worse outcome.”
Researchers used data from a national clinical research database to identify incident cases of UC between 2005 and 2016 (n = 6,754). They separated patients into three groups based on smoking status in the 2 years prior to diagnosis; never smokers (n = 2,698), ex-smokers (n = 3,178) and smokers (n = 878). They also designated subgroups defined as persistent smokers and smokers who quite within 2 years after diagnosis.
Investigators compared disease course among the groups using rates of overall corticosteroid use, corticosteroid-requiring flares, corticosteroid dependency, thiopurine use, hospitalization and colectomy.
Compared with never-smokers, researchers found that smokers had a similar risk for flares (OR = 1.16; 95% CI, 0.92–1.25), thiopurine use (HR = 0.84; 95% CI, 0.62–1.14), corticosteroid dependency (HR = 0.85; 95% CI, 0.6–1.11), hospitalization (HR = 0.92; 95% CI, 0.72–1.18) and colectomy (HR = 0.78; 95% CI, 0.5–1.21).
Patients who smoked at diagnosis and then quit also had similar rates of flares, thiopurine use, corticosteroid dependency, hospitalization and colectomy compared with persistent smokers.
Blackwell and colleagues wrote that their findings showed that smoking does not have a beneficial impact on disease outcomes in UC.
“We found no evidence that smoking cessation impacts adversely on subsequent clinical outcomes,” they wrote. “Our findings should therefore embolden clinicians to advise against smoking and reassure patients who already smoke that they can benefit from the many advantages of smoking cessation without risk of worsening their UC.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.