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Smoking is associated with progressive disease course and increased progression in clinical disability in a prospective cohort of people with multiple sclerosis


Pittas, F and Ponsonby, AL and Van der Mei, IAF and Taylor, BVM and Blizzard, CL and Groom, PS and Ukoumunne, OC and Dwyer, T, Smoking is associated with progressive disease course and increased progression in clinical disability in a prospective cohort of people with multiple sclerosis , Journal of Neurology: Official Journal of The European Neurological Society, 256, (4) pp. 577-585. ISSN 0340-5354 (2009) [Refereed Article]

DOI: doi:10.1007/s00415-009-0120-2


Background Multiple sclerosis has a variable diseasecourse. The contribution of modifiable lifestyle factors to disease course has not been well studied, although one cohort has reported that smoking is associated with conversion to secondary progressive MS course and another that smoking is not. Methods We conducted a prospective cohort study of people with MS in Southern Tasmania from 2002 to 2004 with 78 % (203/259) of eligible participating and 198 with one or more reviews and confirmed MS. The cohort had a high retention rate (90 % (183/203)). The median follow-up time was 909 days. Smoking data were collected at baseline and six-monthly reviews. Clinical disability assessments were conducted annually in conjunction with a real time clinical notification system for relapses. A repeated measures analysis and other statistical methods were used. Results Cumulative pack-years (p-y) smoked after cohort entry was associated with an increase in longitudinal MSSS (p < 0.001). Relative to the 0 pack years (p-y) category (in the year prior to the MSSS measure) those in the 0 to 1 p-y category had an adjusted mean difference in MSSS of 0.34 (95 % CI 0.28, 0.66); those in the 1 to 2 p-y category had a 0.41 (95 % CI –0.03, 0.85) increase; and those in the 2 or more p-y category had a 0.99 (95 % CI 0.41, 1.58) increase in MSSS. Similar results were found using a variety of statistical approaches or EDSS as a clinical outcome. Smoking during the cohort period was not associated with relapse (cumulative pack years smoked after cohort entry, HR 0.94 (0.69, 1.26) per pack year). Conclusion A better understanding of the mechanisms underlying smoking and multiple sclerosis, particularly progressive forms of the disease, may provide new insights for the eventual goal of better treatment and prevention of multiple sclerosis.

Item Details

Item Type:Refereed Article
Keywords:multiple sclerosis, tobacco smoke, prospective cohort, repeated measures, disability
Research Division:Medical and Health Sciences
Research Group:Public Health and Health Services
Research Field:Preventive Medicine
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Nervous System and Disorders
UTAS Author:Pittas, F (Dr Fotini Pittas)
UTAS Author:Ponsonby, AL (Professor Anne Ponsonby)
UTAS Author:Van der Mei, IAF (Associate Professor Ingrid van der Mei)
UTAS Author:Taylor, BVM (Professor Bruce Taylor)
UTAS Author:Blizzard, CL (Professor Leigh Blizzard)
UTAS Author:Groom, PS (Sr Patricia Groom)
UTAS Author:Dwyer, T (Professor Terry Dwyer)
ID Code:59637
Year Published:2009
Web of Science® Times Cited:92
Deposited By:Menzies Institute for Medical Research
Deposited On:2009-12-15
Last Modified:2010-04-15

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