title: Influence of smoking on the efficacy of antimalarials in cutaneous lupus: a meta-analysis of the literature.
abstract: BACKGROUND
  Interaction between smoking and efficacy of antimalarials, the mainstay of treatment for cutaneous lupus erythematosus (CLE), remains controversial.
  
  
  OBJECTIVE
  We systematically reviewed the evidence for such an interaction and performed a meta-analysis to compare the efficacy of antimalarials among smoker versus nonsmoker patients with CLE.
  
  
  METHODS
  Observational studies published up to March 2014 in the MEDLINE, Embase, and Cochrane databases were selected if they reported on the efficacy of antimalarials for treatment of CLE, according to smoking status. The strength of association between smoking and cutaneous response rate was expressed using the odds ratio. Individual study odds ratios were combined in the meta-analysis using a random effects model.
  
  
  RESULTS
  Of 240 citations retrieved, 10 studies met inclusion criteria, for a total of 1398 patients. The pooled odds ratio for the response to antimalarials in smoker patients with CLE (n = 797) was 0.53 (95% confidence interval 0.29-0.98) compared with nonsmokers (n = 601).
  
  
  CONCLUSIONS
  Subgroup analyses for the response to antimalarials considering CLE subtypes, type, and dosage of antimalarials could not be performed because of the lack of available data.
  
  
  CONCLUSIONS
  Smoking is associated with a 2-fold decrease in the proportion of patients with CLE achieving cutaneous improvement with antimalarials. Smoking cessation should be considered in patients with CLE and refractory cutaneous involvement.
authors: AP-HP, Groupement Hospitalier Pitié-Salpêtrière, E3M Institute, Internal Medicine Department, French National Reference Center for Systemic Lupus Erythematosus, Paris, France; Department of Dermatology and Allergology Tenon Hospital-APHP, Paris, France.
authors: François
authors: F
authors: Chasset
authors: Department of Dermatology and Allergology Tenon Hospital-APHP, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, Paris, France.
authors: Camille
authors: C
authors: Francès
authors: Department of Dermatology and Allergology Tenon Hospital-APHP, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, Paris, France.
authors: Stéphane
authors: S
authors: Barete
authors: AP-HP, Groupement Hospitalier Pitié-Salpêtrière, E3M Institute, Internal Medicine Department, French National Reference Center for Systemic Lupus Erythematosus, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, Paris, France.
authors: Zahir
authors: Z
authors: Amoura
authors: AP-HP, Groupement Hospitalier Pitié-Salpêtrière, E3M Institute, Internal Medicine Department, French National Reference Center for Systemic Lupus Erythematosus, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, Paris, France; INSERM UMR-S 1136, GRC 08, Institut Pierre Louis d'Epidémiologie et Santé Publique, Paris, France. Electronic address: Laurent.arnaud@psl.aphp.fr.
authors: Laurent
authors: L
authors: Arnaud
mesh_terms: D000962:Antimalarials / Q000493:pharmacokinetics / Q000627:therapeutic use*; D015984:Causality; D002738:Chloroquine / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002921:Cicatrix / Q000209:etiology / Q000473:pathology; D015897:Comorbidity; D004351:Drug Resistance; D006801:Humans; D006886:Hydroxychloroquine / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use*; D008178:Lupus Erythematosus, Cutaneous / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D064887:Observational Studies as Topic; D016017:Odds Ratio; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012907:Smoking / Q000097:blood* / Q000453:epidemiology; D016540:Smoking Cessation
chemical_list: D000962:Antimalarials; D006886:Hydroxychloroquine; D002738:Chloroquine
keywords: antimalarials; cutaneous; hydroxychloroquine; lupus erythematosus; smoking; tobacco