Wednesday, 9 September 2015

Time to Quit

Ramanujam R, Hedström AK, Manouchehrinia A, Alfredsson L, Olsson T, Bottai M, Hillert J. Effect of Smoking Cessation on Multiple Sclerosis Prognosis. JAMA Neurol. 2015:1-7. doi: 10.1001/jamaneurol.2015.1788. [Epub ahead of print]

IMPORTANCE:Smoking tobacco is a well-established risk factor for multiple sclerosis (MS), a chronic inflammatory disorder of the central nervous system usually characterized by bouts and remissions and typically followed by a secondary progressive (SP) course. However, it is not clear whether smoking after diagnosis is detrimental.
OBJECTIVE: To determine whether smoking after MS diagnosis is associated with a change in time to SP disease.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of patients with prevalent MS who smoked at diagnosis (n = 728) taken from the Genes and Environment in Multiple Sclerosis Study, which consists of patients from the Swedish National MS Registry. The study entrance date was at time of first-year smoking. The study was conducted between November 2008 and December 2011, with patient environmental data collected from November 2009 to March 2011 via questionnaire. Study participants were from all counties in Sweden diagnosed as having MS at the time of the Genes and Environment in Multiple Sclerosis Study and registered in the Swedish National MS Registry. Patients with MS with relapsing-remitting disease course or SP were included. These patients' conditions were diagnosed according to the McDonald criteria and the patients responded to recruitment letters with detailed questionnaires.
EXPOSURE: Smoking, considered yearly after diagnosis and combined into a time-invariant covariate before diagnosis.
MAIN OUTCOMES AND MEASURES: Time to SPMS, measured using an accelerated failure time model, with smoking as a time-varying covariate. Other covariates included sex, age at diagnosis, snuff use, and smoking before diagnosis.
RESULTS: The optimized model illustrated that each additional year of smoking after diagnosis accelerated the time to conversion to SPMS by 4.7% (acceleration factor, 1.047; 95% CI, 1.023-1.072; P < .001). Kaplan-Meier plots demonstrated that those who continued to smoke continuously each year after diagnosis converted to SPMS faster than those who quit smoking, reaching SP disease at 48 and 56 years of age, respectively.
CONCLUSIONS AND RELEVANCE: This study provides evidence that continued smoking is associated with an acceleration in time to SPMS and that those who quit fare better. Therefore, we propose that patients with MS should be advised to stop smoking once a diagnosis has been made, not only to lessen risks for comorbidities, but also to avoid aggravating MS-related disability.

ProfG has been very clear on his thoughts about this issue, but this is yet more evidence that smoking on balance is not good for you and you are more likely to progressive faster...Is it you are less stressed? I don't know

If you smoke you already know this and you would appreciate not being told again and again. There are many ways to stop and you can get help from your GP to do this.

Pick your time, your method your reward and do it on your own terms.


  1. We all know that smoking is bad, and bad for MS, but the stresses of living with MS make it even harder to quit............

  2. Is there any research about cigar smoking and MS? I smoke about 1.5 cigars per week on average, my social life and professional networking are built around cigars. Am trying to understand the risk.

  3. It should not take a diagnosis of MS for people to quit smoking. "However, it is not clear whether smoking after diagnosis is detrimental." ?? I know it is in the context of worsening MS but are there any conditions where smoking is beneficial? Maybe anxiety disorders.

    1. Long established that nicotine has neuroprtective properties. Long known to be an inverse relationship between smoking and Parkinson's disease for example.

  4. Smoking seems not good for anxiety. Some doctors say anxiety is common in MS and can make MS symptoms worse. It seems to be a vicious circle, as this paper suggests smoking can increase the risk of developing anxiety.

    Evidence suggests that individuals with increased anxiety are more likely to smoke (Brown et al. 1996; Patton et al. 1998; Sonntag et al. 2000; Goodwin et al. 2005; Cuijpers et al. 2007; Swendsen et al. 2010). Multiple factors have been proposed to explain this, including use of cigarettes to reduce anxiety (i.e., self-treatment) and an increased susceptibility of those with anxiety in initiating smoking in response to peer pressure (Patton et al. 1998; Tjora et al. 2011). In addition, smoking appears to increase the risk of developing increased anxiety (Breslau and Klein 1999; Johnson et al. 2000; Isensee et al. 2003; Goodwin et al. 2005; Cuijpers et al. 2007; Pedersen and von Soest 2009).

    How cigarette smoking may increase the risk of anxiety symptoms and anxiety disorders: a critical review of biological pathways

    1. This makes me think if anxiety aggravates MS symptoms and smoking may increase the risk of anxiety symptoms there is no way I want to smoke.

    2. This 2015 article is interesting:

      Adverse health behaviours are associated
      with depression and anxiety in multiple
      sclerosis: A prospective multisite study.

      Alcohol dependence and smoking were associated with anxiety and depression. Awareness of the effects of adverse health behaviours on mental health in MS might help target counselling and support for those ‘at risk’.

  5. This post is contradictory with the one you published last sunday. Shouldn't you at least mention (again) your thought that nicotin (through alternative paths like patches or e-cigarrettes) might be benefitial?

    1. There's a lot more than just nicotine in cigarette smoke. The potential benefit of nicotine as a neuroprotective agent seems to have a lot of evidence so nicotine (but not taken by smoking) may be useful.


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