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Does Smoking Influence Crohn's Disease in the Biologic Era? The TABACROHN Study

Nunes, Tiago MD1,†; Etchevers, Maria Josefina MD1,†; Merino, Olga MD, PhD2; Gallego, Sonia MD3; García-Sánchez, Valle MD, PhD4; Marín-Jiménez, Ignacio MD, PhD5; Menchén, Luis MD5; Acosta, Manuel Barreiro-de MD, PhD6; Bastida, Guillermo MD7,†; García, Sara MD8; Gento, Elena MD8; Ginard, Daniel MD, PhD9; Gomollón, Fernando MD, PhD10; Arroyo, Maite MD, PhD10; Monfort, David MD11; García-Planella, Esther MD12; Gonzalez, Benito MD13; Loras, Carme MD, PhD14; Agustí, Carles MD1,†; Figueroa, Carolina MD1,†; Sans, Miquel MD, PhD1,†; for the TABACROHN Study Group of GETECCU, Spanish Working Group in Crohn's Disease and Ulcerative Colitis

doi: 10.1002/ibd.22959
Original Clinical Articles

Background: While most studies have found a negative effect of smoking on Crohn's disease (CD) phenotype, more recent data have failed to reproduce this association, which might be due to a current wider use of thiopurines and biologic therapy. The TABACROHN study aimed at defining the impact of smoking on CD in the largest published series.

Methods: This multicenter cross-sectional study included 1170 CD patients. Patients were classified as nonsmokers, current smokers, or former smokers according to their present smoking status. Clinical data regarding disease characteristics, treatment, and complications were collected.

Results: Smokers were more frequently under maintenance treatment when compared to nonsmokers. In addition, current smokers presented higher use of biologic drugs compared to nonsmokers. Tobacco exposure and a higher tobacco load were independent predictors of need for maintenance treatment and stenosing phenotype, respectively.

Conclusions: In the era of early and widespread use of immunosuppressants and biologics, tobacco exposure is an independent predictor of need for maintenance treatment, specifically biologic therapy. The wider use of biologics and immunosuppressants could account for the existence of no major differences in disease behavior and complications between nonsmokers and current smokers.

Article first Published online 29 March 2012

1Hospital Clinic/IDIBAPS, Barcelona

2Hospital de Cruces, Barakaldo

3Hospital Miguel Servet, Zaragoza

4Hospital Reina Sofia, Córdoba

5Hospital Gregorio Marañón, Madrid

6Hospital Clinico Universitario, Santiago de Compostela

7Hospital La Fe, Valencia

8Hospital general Yague, Burgos

9Hospital Universitario Son Espases, Palma de Mallorca

10Hospital Clinico, Zaragoza

11Consorci Sanitari de Terrassa, Terrassa

12Hospital Sant Pau, Barcelona

13Hospital Juan Canalejo, A Coruña

14Hospital Mutua de Terrassa, Terrassa, Spain.

Reprints: Miquel Sans, MD, PhD, Department of Gastroenterology, Hospital Clínic i Provincial / IDIBAPS, 170 Villarroel, 08036 Barcelona, Spain (e-mail: msans@clinic.ub.es).

The first two authors contributed equally to this work.

† CIBEREHD: Centro de investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas.

Received February 24, 2012

Accepted February 28, 2012

© Crohn's & Colitis Foundation of America, Inc.
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