• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (17)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Neurology  • Multiple Sclerosis/ Demyelinating Disease  • Public Health  • Tobacco  • Immunologic Disorders  • Alert me on articles by topic  Social Bookmarking   What's this?

Brian C. Healy, PhD; Eman N. Ali, MD; Charles R. G. Guttmann, MD; Tanuja Chitnis, MD; Bonnie I. Glanz, PhD; Guy Buckle, MD; Maria Houtchens, MD; Lynn Stazzone, MSN, NP; Jennifer Moodie, MD; Annika M. Berger, MD; Yang Duan, MD; Rohit Bakshi, MD; Samia Khoury, MD; Howard Weiner, MD; Alberto Ascherio, MD

Arch Neurol. 2009;66(7):858-864.

Background  Although cigarette smokers are at increased risk of developing multiple sclerosis (MS), the effect of smoking on the progression of MS remains uncertain.

Objective  To establish the relationship between cigarette smoking and progression of MS using clinical and magnetic resonance imaging outcomes

Design  Cross-sectional survey and longitudinal follow-up for a mean of 3.29 years, ending January 15, 2008.

Setting  Partners MS Center (Boston, Massachusetts), a referral center for patients with MS.

Patients  Study participants included 1465 patients with clinically definite MS (25.1% men), with mean (range) age at baseline of 42.0 (16-75) years and disease duration of 9.4 (0-50.4) years. Seven hundred eighty patients (53.2%) were never-smokers, 428 (29.2%) were ex-smokers, and 257 (17.5%) were current smokers.

Main Outcome Measures  Smoking groups were compared for baseline clinical and magnetic resonance imaging characteristics as well as progression and sustained progression on the Expanded Disability Status Scale at 2 and 5 years and time to disease conversion to secondary progressive MS. In addition, the rate of on-study change in the brain parenchymal fraction and T2 hyperintense lesion volume were compared.

Results  Current smokers had significantly worse disease at baseline than never-smokers in terms of Expanded Disability Status Scale score (adjusted P < .001), Multiple Sclerosis Severity Score (adjusted P < .001), and brain parenchymal fraction (adjusted P = .004). In addition, current smokers were significantly more likely to have primary progressive MS (adjusted odds ratio, 2.41; 95% confidence interval, 1.09-5.34). At longitudinal analyses, MS in smokers progressed from relapsing-remitting to secondary progressive disease faster than in never-smokers (hazard ratio for current smokers vs never-smokers, 2.50; 95% confidence interval, 1.42-4.41). In addition, in smokers, the T2-weighted lesion volume increased faster (P = .02), and brain parenchymal fraction decreased faster (P = .02).

Conclusion  Our data suggest that cigarette smoke has an adverse influence on the progression of MS and accelerates conversion from a relapsing-remitting to a progressive course.

Author Affiliations: Department of Neurology, Partners MS Center (Drs Healy, Ali, Guttmann, Chitnis, Glanz, Buckle, Houtchens, Moodie, Bakshi, Khoury, and Weiner and Ms Stazzone), Center for Neurological Imaging, Department of Radiology (Drs Guttmann, Berger, Duan, and Bakshi), and Channing Laboratory, Department of Medicine (Dr Ascherio), Brigham and Women's Hospital, Harvard Medical School; Biostatistics Center, Department of Neurology, Massachusetts General Hospital (Dr Healy); and Departments of Epidemiology and Nutrition, Harvard School of Public Health (Dr Ascherio), Boston, Massachusetts.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

This Month in Archives of Neurology
Arch Neurol. 2009;66(7):817-818.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Smoking: effects on multiple sclerosis susceptibility and disease progression
Wingerchuk
Therapeutic Advances in Neurological Disorders 2012;5:13-22.
ABSTRACT  

Cigarette Smoke Induces DNA Damage and Alters Base-Excision Repair and Tau Levels in the Brain of Neonatal Mice
La Maestra et al.
Toxicol Sci 2011;123:471-479.
ABSTRACT | FULL TEXT  

Demographic and clinical characteristics of malignant multiple sclerosis
Gholipour et al.
Neurology 2011;76:1996-2001.
ABSTRACT | FULL TEXT  

A case-control study of risk factors for multiple sclerosis in Iran
Alonso et al.
Mult Scler 2011;17:550-555.
ABSTRACT | FULL TEXT  

Factors predisposing to the development of multiple sclerosis
Young
QJM 2011;104:383-386.
ABSTRACT | FULL TEXT  

Modifiable factors influencing relapses and disability in multiple sclerosis
D'hooghe et al.
Mult Scler 2010;16:773-785.
ABSTRACT