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MS progression worse in patients who smoke

Secondary progressive disease occurs sooner in those who still smoke after MS diagnosis

Louise Prime

Tuesday, 08 September 2015

People who continued to smoke after a diagnosis of multiple sclerosis experienced accelerated disease progression compared with smokers who quit after their MS diagnosis, and reached secondary progressive (SP) disease at a younger age than quitters, according to a study* published today in JAMA Neurology. Its authors said that, as a result, patients should be encouraged to quit smoking even after an MS diagnosis.

Smoking is a known risk factor for MS – about 60% of newly diagnosed MS patients are smokers – but its effect on disease progression was not known. Researchers led from the Karolinska Institutet in Stockholm studied 728 people who were smokers at the time of MS diagnosis, of whom 216 converted to SP during follow up. They compared the health of 118 ‘quitters’ who stopped smoking in the year of diagnosis, with the health of 332 ‘continuers’ who carried on smoking; and also with that of 1,012 never-smokers.

The study authors found that time to SP conversion was accelerated by 4.7% for every additional year of smoking after MS diagnosis. People who carried on smoking converted to SP at the age of 48, on average, compared with 56 years old in people who had quit.

They said: “This study demonstrates that smoking after MS diagnosis has a negative impact on the progression of the disease, whereas reduced smoking may improve patient quality of life, with more years before the development of SP disease. Accordingly, evidence clearly supports advising patients with MS who smoke to quit. Health care services for patients with MS should be organised to support such a lifestyle change.”

However, they did point out that it was impossible to rule out all other confounding factors. The authors of a related commentary** said: “This study adds to the important research demonstrating that smoking is an important modifiable risk factor in MS. Most importantly, it provides the first evidence, to our knowledge, that quitting smoking appears to delay onset of secondary progressive MS and provide protective benefit. Therefore, even after MS diagnosis, smoking is a risk factor worth modifying.”

* Ryan Ramanujam, et al. Effect of Smoking Cessation on Multiple Sclerosis Prognosis. JAMA Neurol. Published online September 8, 2015. doi:10.1001/jamaneurol.2015.1788

** Myla D. Goldman, Olaf Stüve. Smoking Beyond Multiple Sclerosis Diagnosis - A Risk Factor Still Worth Modifying. JAMA Neurol. Published online September 08, 2015. doi:10.1001/jamaneurol.2015.1805

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