Accepted for/Published in: JMIR Human Factors
Date Submitted: Jan 7, 2026
Date Accepted: Feb 9, 2026
The impact of tobacco smoking on the treatment response among psoriasis patients with biologic treatment: a prospective study
ABSTRACT
Background:
Tobacco smoking is viewed as a behavioral risk factor for psoriasis initiation and progress, even among those with biologic treatment. However, evidence regarding the association between tobacco smoking and treatment response to biologics among psoriasis patients is limited.
Objective:
This study aims to explore the impact of tobacco smoking on the efficacy of biologic treatment in psoriasis patients.
Methods:
Psoriasis patients with biologic treatment were recruited from 2022 and 2024 in Shanghai Skin Disease Hospital. Demographic features and smoking habits were collected using a structured questionnaire. Clinical features and treatment efficacy were assessed and recorded by dermatologists at baseline and at week 4, 8, 12, 24, and 48 after treatment, and PASI75 and PASI90 were calculated for treatment efficacy evaluation.
Results:
192 psoriasis patients were included, among whom 78 (40.6%) were tobacco smokers, with a higher smoking prevalence observed in male patients. The PASI75 response rates at week 4, 8, 12, 24 and 48 were 29.2%, 54.2%, 78.6%, 84.5% and 82.7%, respectively. The PASI90 response rates increased from 13.0% at week 4 to 62.4% at week 24 and 59.9% at week 48. Logistic regression analysis indicated that psoriasis patients without smoking had high PASI75 response rate, the adjusted odds ratio (OR) was 2.57 (95% CI: 1.19–5.53) at week 4, 2.61 (95% CI: 1.34–5.08) at week 8, 2.62 (95% CI: 1.13–6.04) at week 12, 2.27 (95% CI: 0.89–5.75) at week 24 and 2.75 (95% CI: 1.01–7.49) at week 48. Moreover, psoriasis patients without smoking also had high PASI90 response rate than those with smoking, the OR ranged from 1.32 to 2.59. Correlation analysis showed that both of tobacco smoking duration and daily cigarette consumption were negatively correlated with the reduction in PASI score at week 4 to week 48 after treatment (p<0.05).
Conclusions:
Tobacco smoking was negatively associated with the treatment response among psoriasis patients with biologic treatment, especially among patients with longer tobacco smoking duration and more daily cigarette consumption.
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