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Cited by 184Multiple Sclerosis Research StudiesSmoking Behavior and CessationPsoriasis: Treatment and Pathogenesis

Tobacco smoking and disability progression in multiple sclerosis: United Kingdom cohort study

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Manouchehrinia, Ali, Tench, Christopher R., Maxted, Jonathan, Bibani, Rashid H., Britton, John, Constantinescu, Cris S.·2013·Brain
DOI 10.1093/brain/awt139PMC PMC3692034
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Abstract

Tobacco smoking has been linked to an increased risk of multiple sclerosis. However, to date, results from the few studies on the impact of smoking on the progression of disability are conflicting. The aim of this study was to investigate the effects of smoking on disability progression and disease severity in a cohort of patients with clinically definite multiple sclerosis. We analysed data from 895 patients (270 male, 625 female), mean age 49 years with mean disease duration 17 years. Forty-nine per cent of the patients were regular smokers at the time of disease onset or at diagnosis (ever-smokers). Average disease severity as measured by multiple sclerosis severity score was greater in ever-smokers, by 0.68 (95% confidence interval: 0.36-1.01). The risk of reaching Expanded Disability Status Scale score milestones of 4 and 6 in ever-smokers compared to never-smokers was 1.34 (95% confidence interval: 1.12-1.60) and 1.25 (95% confidence interval: 1.02-1.51) respectively. Current smokers showed 1.64 (95% confidence interval: 1.33-2.02) and 1.49 (95% confidence interval: 1.18-1.86) times higher risk of reaching Expanded Disability Status Scale scores 4 and 6 compared with non-smokers. Ex-smokers who stopped smoking either before or after the onset of the disease had a significantly lower risk of reaching Expanded Disability Status Scale scores 4 (hazard ratio: 0.65, confidence interval: 0.50-0.83) and 6 (hazard ratio: 0.69, confidence interval: 0.53-0.90) than current smokers, and there was no significant difference between ex-smokers and non-smokers in terms of time to Expanded Disability Status Scale scores 4 or 6. Our data suggest that regular smoking is associated with more severe disease and faster disability progression. In addition, smoking cessation, whether before or after onset of the disease, is associated with a slower progression of disability.

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Cited by

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Authors
Manouchehrinia, A., Tench, C. R., Maxted, J., Bibani, R. H., Britton, J., & Constantinescu, C. S.
Affiliations
University of Nottingham (GB)
Corresponding author
Constantinescu, Cris S.
ORCID
Venue
Brain
Publisher
Oxford University Press (OUP)
Published
2013-06-11
Volume
136
Issue
7
Pages
2298-2304
ISSN
  • 0006-8950 (ISSN-L)
  • 1460-2156
DOI
10.1093/brain/awt139
PMC
PMC3692034
OpenAlex
W2061621344
Cited by
184
References
2
Citations by year
2026: 17 · 2025: 10 · 2024: 14 · 2023: 9 · 2022: 9 · 2021: 12 · 2020: 14 · 2019: 11 · 2018: 21 · 2017: 18 · 2016: 11 · 2015: 18 · 2014: 15 · 2013: 5
FWCI
12.24
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • Brain (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Nottingham ePrints (University of Nottingham) (submittedVersion, cc-by-nc)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
Funders
  • Medical Research Council (MR/K023195/1)
  • Economic and Social Research Council (ES/G007489/1)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Life Sciences › Immunology and Microbiology › Immunology › Psoriasis: Treatment and Pathogenesis
Keywords
smoking, multiple sclerosis, disability progression, smoking cessation, disease severity, Expanded Disability Status Scale, Multiple Sclerosis Severity Score, current smokers, former smokers
MeSH terms
Adult, Aged, Disability Evaluation, Female, United Kingdom, Persons with Disabilities, Disabled Persons, Humans, Male, Middle Aged, Multiple Sclerosis, Risk Factors, Severity of Illness Index, Smoking, Cohort Studies, Linear Models, Disease Progression, Kaplan-Meier Estimate

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