Smoking and Making your Drugs Stop Working

Hedström A, Alfredsson L, Lundkvist Ryner M, Fogdell-Hahn A, Hillert J, Olsson T. Smokers run increased risk of developing anti-natalizumab antibodies. Mult Scler. 2013 Dec. [Epub ahead of print]

BACKGROUND:Smoking may contribute to the induction of neutralizing antibodies to interferon β-1a.
OBJECTIVE:In this study, we aimed to investigate the influence of smoking on the risk of developing antibodies to natalizumab, another biological drug in the treatment of multiple sclerosis.
METHODS: This report is based on 1338 natalizumab-treated multiple sclerosis patients included in either of two Swedish case-control studies in which information on smoking habits was collected. Using logistic regression, patients with different smoking habits were compared regarding risk of developing anti-natalizumab antibodies, by calculating odds ratios with 95% confidence intervals.
RESULTS: Compared with nonsmokers, the odds ratio of developing anti-natalizumab antibodies was 2.4 (95% CI 1.2-4.4) for patients who smoked at the time of screening, and a significant trend showed higher risk of developing antibodies with higher intensity of smoking. When smoking within two years prior to screening was considered, the odds ratio of developing anti-natalizumab antibodies was 2.7 (1.5-5.1).
INTERPRETATIONS:The finding strengthens our hypothesis of the lungs as immune-reactive organs on irritation in relation to autoimmune responses, and may also be of clinical relevance since antibodies against natalizumab abrogate the therapeutic effect of the treatment.

Yet more anti-smoking news. This study suggests that smokers are twice as likely to develop neutralising antibodies, which will stop the treatment working, as non-smokers. Now it is suggested that smoking affects MS risk and other aspects. Is this telling us that B cells are more important than T cells when it comes to MS. This study implies the reason is that cells that traffic into the CNS go to the lung first so the smoke filled lungs influence immunity. This idea was based on cell trafficking studies, where it is clear the lungs act as a filter for most of the injected cells There are other studies, which do not support this view of trafficking and the first question is why would they need to do this, it seems overly complicated?

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