{
  "abstract": "Background/Objectives: Anti-tumor necrosis factor (anti-TNF) switching remains common in radiographic axial spondyloarthritis (r-axSpA). We aimed to evaluate cumulative smoking burden and clinical factors associated with anti-TNF switching. Methods: This retrospective single-center cohort included 212 patients with r-axSpA. Clinical data were collected from medical records. Bivariate comparisons, Kaplan–Meier analysis and multivariable Cox regression assessed switching, with a cause-specific sensitivity analysis for lack-of-response switching. Results: Eighty patients (37.7%) switched initial anti-TNF agent, including 70 (87.5%) for lack of response. While the global comparison of smoking status was nonsignificant (p = 0.105), exploratory unadjusted comparisons of current smokers versus former and never-smokers combined showed associations with all-cause (p = 0.035) and lack-of-response switching (p = 0.012). In adjusted Cox analysis, cumulative smoking burden was associated with increased switching hazard (HR 1.025 per pack-year, 95% CI 1.011–1.039; p < 0.001), alongside peripheral articular involvement (HR: 2.0, 95% CI 1.216–3.296, p = 0.006), higher BASDAI at anti-TNF initiation (HR: 1.02, 95% CI 1.004–1.029, p = 0.007) and later calendar year of treatment initiation (HR: 1.24, 95% CI 1.107–1.394, p < 0.001). Smoking burden >20 pack-years was associated with a higher adjusted switching hazard compared with never-smokers (HR 3.54, 95% CI 2.081–6.033; p < 0.001). Among ever-smokers, Kaplan–Meier comparisons showed shorter drug survival with >20 versus ≤10 and >10–20 pack-years (both p < 0.001). Conclusions: Cumulative smoking burden was associated with an increased hazard of anti-TNF switching, particularly among patients with >20 pack-years. Quantifying smoking exposure may provide additional information beyond smoking status alone.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Internal Medicine, Division of Rheumatology, Trakya University Faculty of Medicine, 22030 Edirne, Türkiye",
    "Department of Hematology, Edirne Sultan 1. Murat State Hospital, 22030 Edirne, Türkiye",
    "Department of Rheumatology, İskenderun Gelisim Hospital, 31200 Hatay, Türkiye"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Ahmet Yigitbasi",
      "orcid": "0000-0001-6216-595X"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Baris Yilmazer"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/44enjxk42y139.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15218208",
  "fulltext_url": null,
  "id": "44enjxk42y139",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/21/8208",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2745|Spondyloarthritis Studies and Treatments"
    ]
  ],
  "openalex": "W7223185540",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-22",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/44enjxk42y139.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:01Z",
      "native_id": "10.3390/jcm15218208",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/21/8208"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2745|Spondyloarthritis Studies and Treatments",
      "subfield": "general"
    }
  ],
  "title": "Clinical Factors and Cumulative Smoking Burden Associated with Anti-TNF Switching in Radiographic Axial Spondyloarthritis: A Real-World Cohort Study",
  "title_text": "Clinical Factors and Cumulative Smoking Burden Associated with Anti-TNF Switching in Radiographic Axial Spondyloarthritis: A Real-World Cohort Study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:01Z",
  "url": "https://research.draconitic.com/paper/44enjxk42y139",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}