Highlights
- •We evaluated the effect of smoking on the efficacy of oral DMDs in MS patients.
- •Current smoking was a risk factor for relapse in MS patients under oral DMDs.
- •Disease course of former-smokers was similar to that of never-smokers.
- •MS patients should be advised to stop smoking even after initiation of oral DMDs.
Abstract
Background
In relapsing-remitting multiple sclerosis (RRMS), smoking is a known risk factor for
disease susceptibility and disability progression. However, its impact on the efficacy
of oral disease-modifying drugs (DMDs) is unclear. Therefore, we initiated a single-center,
retrospective, observational study to investigate the relationship between smoking
and disease activity in RRMS patients under oral DMDs.
Methods
We retrospectively enrolled RRMS patients who initiated oral DMDs (fingolimod or dimethyl
fumarate) at our hospital between January 2012 and December 2019. Clinical data and
smoking status at oral DMD initiation were collected up to December 2020. We conducted
survival analyses for relapse and any disease activity, defined as relapse or MRI
disease activity, among patients with distinct smoking statuses.
Results
We enrolled 103 RRMS patients under oral DMDs including 19 (18.4%) current smokers
at baseline. Proportions of relapses and any disease activity during follow-up were
higher in current smokers (relapse: p = 0.040, any disease activity: p = 0.004) and time from initiating oral DMDs to relapse was shorter in current smokers
(log-rank test: p = 0.011; Cox proportional hazard analysis: hazard ratio (HR) 2.72 [95% confidence
interval (CI) 1.22–6.09], p = 0.015) than in non-smokers. Time from initiating oral DMDs to any disease activity
was also shorter in current smokers (log-rank test: p = 0.016; Cox proportional hazard analysis: HR 2.18 [95% CI 1.14–4.19], p = 0.019) than in non-smokers. The survival curves for relapse and any disease activity
were not different between the former smoker and never-smoker groups. Multivariate
survival analysis showed current smoking was an independent risk factor for relapse
or any disease activity after adjusting for covariates (relapse: HR 2.54 [95% CI 1.06–6.10],
p = 0.037; any disease activity: HR 3.47 [95% CI 1.27–9.50], p = 0.015).
Conclusion
Smoking was a risk factor for disease activity in RRMS patients under oral DMD treatment.
RRMS patients should be advised to stop smoking even after the initiation of DMDs.
Keywords
Abbreviations:
ARR (annualized relapse rates), CI (confidence intervals), CSF (cerebrospinal fluid), DMD (disease modifying drug), DMF (dimethyl fumarate), EDSS (Kurtzke's expanded disability status scale), FTY (fingolimod), GA (glatiramer acetate), HR (hazard ratio), IFN-β (interferon-beta), IQR (interquartile range), MS (multiple sclerosis), MSSS (multiple sclerosis severity score), NEDA (no evidence of disease activity), NOx (nitrogen oxide), OCBs (oligoclonal IgG bands), PSL (prednisolone), RRMS (relapsing-remitting multiple sclerosis), SPMS (secondary progressive multiple sclerosis)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 09, 2023
Accepted:
January 9,
2023
Received in revised form:
November 22,
2022
Received:
June 15,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
