Radu Tanasescu1,2,3, Cris S Constantinescu1, Christopher R Tench1, Ali Manouchehrinia4. 1. Academic Clinical Neurology, Division of Clinical Neuroscience, University of Nottingham, UK. 2. Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania. 3. Department of Neurology, Colentina Hospital, Bucharest, Romania. 4. Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.
Abstract
Background: Smoking is associated with a more severe disease course in people with multiple sclerosis (MS). The magnitude of effect of smoking cessation on MS progression is unknown. The aim of this study was to quantify the impact of smoking cessation on reaching MS disability milestones. Aims and Methods: This is a cross-sectional study with retrospective reports. A comprehensive smoking questionnaire was sent to 1270 patients with MS registered between 1994 and 2013 in the Nottingham University Hospital MS Clinics database. Demographic and clinical data were extracted from the clinical database. Cox proportional hazard regression was used to estimate effects of smoke-free years on the time to Expanded Disability Status Scale (EDSS) scores 4.0 and 6.0. MS Impact Scale 29 and Patient Determined Disease Steps were used to assess the physical and psychological impact of smoking. Results: Each "smoke-free year" was associated with 0.96 (95% confidence interval: 0.95 to 0.97) times decreased risk of reaching EDSS 4.0 and 0.97 (95% confidence interval: 0.95 to 0.98) times decreased risk of reaching EDSS 6.0. Nonsmokers showed a significantly lower level of disability in all the self-reported outcomes compared with current smokers. Conclusions: The reduction in the risk of disability progression after smoking cessation is significant and time dependent. The earlier the patients quit, the stronger the reduction in the risk of reaching disability milestones. The quantitative estimates of the impact of smoking cessation on reaching disability milestones in MS can be used in interventional trials. Implications: This study provides for the first time quantitative estimates of the effects of smoking cessation in MS, essential for informing smoking cessation trials. The clear effect of smoking cessation on MS progression suggests the need to consider adjusting for smoking cessation when assessing for treatment effects in clinical trials of treatments for MS. Smoking cessation should be an early intervention in people with MS.
Background: Smoking is associated with a more severe disease course in people with multiple sclerosis (MS). The magnitude of effect of smoking cessation on MS progression is unknown. The aim of this study was to quantify the impact of smoking cessation on reaching MS disability milestones. Aims and Methods: This is a cross-sectional study with retrospective reports. A comprehensive smoking questionnaire was sent to 1270 patients with MS registered between 1994 and 2013 in the Nottingham University Hospital MS Clinics database. Demographic and clinical data were extracted from the clinical database. Cox proportional hazard regression was used to estimate effects of smoke-free years on the time to Expanded Disability Status Scale (EDSS) scores 4.0 and 6.0. MS Impact Scale 29 and Patient Determined Disease Steps were used to assess the physical and psychological impact of smoking. Results: Each "smoke-free year" was associated with 0.96 (95% confidence interval: 0.95 to 0.97) times decreased risk of reaching EDSS 4.0 and 0.97 (95% confidence interval: 0.95 to 0.98) times decreased risk of reaching EDSS 6.0. Nonsmokers showed a significantly lower level of disability in all the self-reported outcomes compared with current smokers. Conclusions: The reduction in the risk of disability progression after smoking cessation is significant and time dependent. The earlier the patients quit, the stronger the reduction in the risk of reaching disability milestones. The quantitative estimates of the impact of smoking cessation on reaching disability milestones in MS can be used in interventional trials. Implications: This study provides for the first time quantitative estimates of the effects of smoking cessation in MS, essential for informing smoking cessation trials. The clear effect of smoking cessation on MS progression suggests the need to consider adjusting for smoking cessation when assessing for treatment effects in clinical trials of treatments for MS. Smoking cessation should be an early intervention in people with MS.
Authors: Peter A Maple; Alberto Ascherio; Jeffrey I Cohen; Gary Cutter; Gavin Giovannoni; Claire Shannon-Lowe; Radu Tanasescu; Bruno Gran Journal: Front Neurol Date: 2022-06-24 Impact factor: 4.086
Authors: Saskia Elkhalii-Wilhelm; Anna Sippel; Karin Riemann-Lorenz; Christopher Kofahl; Jutta Scheiderbauer; Sigrid Arnade; Ingo Kleiter; Stephan Schmidt; Christoph Heesen Journal: PLoS One Date: 2022-05-27 Impact factor: 3.752
Authors: Roos M van der Vuurst de Vries; Julia Y Mescheriakova; Tessel F Runia; Theodora A M Siepman; Beatrijs H A Wokke; Johnny P A Samijn; Rogier Q Hintzen Journal: J Neurol Date: 2018-02-20 Impact factor: 4.849
Authors: Ali Manouchehrinia; Jesse Huang; Jan Hillert; Lars Alfredsson; Tomas Olsson; Ingrid Kockum; Cris S Constantinescu Journal: Front Immunol Date: 2022-03-03 Impact factor: 7.561
Authors: Jeff Rodgers; Tim Friede; Frederick W Vonberg; Cris S Constantinescu; Alasdair Coles; Jeremy Chataway; Martin Duddy; Hedley Emsley; Helen Ford; Leonora Fisniku; Ian Galea; Timothy Harrower; Jeremy Hobart; Huseyin Huseyin; Christopher M Kipps; Monica Marta; Gavin V McDonnell; Brendan McLean; Owen R Pearson; David Rog; Klaus Schmierer; Basil Sharrack; Agne Straukiene; Heather C Wilson; David V Ford; Rod M Middleton; Richard Nicholas Journal: Brain Date: 2022-05-24 Impact factor: 15.255
Authors: João J Cerqueira; D Alastair S Compston; Ruth Geraldes; Mario M Rosa; Klaus Schmierer; Alan Thompson; Michela Tinelli; Jacqueline Palace Journal: J Neurol Neurosurg Psychiatry Date: 2018-04-04 Impact factor: 10.154