Tanaka Eizo, Watanabe Mitsuru, Fukumoto Shoko, Masaki Katsuhisa, Yamasaki Ryo, Matsushita Takuya, Isobe Noriko
Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Mult Scler Relat Disord. 2023 Feb;70:104513. doi: 10.1016/j.msard.2023.104513. Epub 2023 Jan 10.
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.
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.
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).
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.
在复发缓解型多发性硬化症（RRMS）中，吸烟是已知的疾病易感性和残疾进展的风险因素。然而，其对口服疾病修正药物（DMDs）疗效的影响尚不清楚。因此，我们开展了一项单中心、回顾性、观察性研究，以调查口服DMDs的RRMS患者吸烟与疾病活动之间的关系。
我们回顾性纳入了2012年1月至2019年12月在我院开始口服DMDs（芬戈莫德或富马酸二甲酯）的RRMS患者。收集截至2020年12月的临床数据和口服DMDs开始时的吸烟状况。我们对不同吸烟状态患者的复发及任何疾病活动（定义为复发或MRI疾病活动）进行了生存分析。
我们纳入了103例接受口服DMDs治疗的RRMS患者，其中19例（18.4%）在基线时为当前吸烟者。随访期间，当前吸烟者的复发率和任何疾病活动发生率均较高（复发：p = 0.040，任何疾病活动：p = 0.004），且当前吸烟者从开始口服DMDs到复发的时间较短（对数秩检验：p = 0.011；Cox比例风险分析：风险比（HR）2.72 [95%置信区间（CI）1.22 - 6.09]，p = 0.015），短于非吸烟者。当前吸烟者从开始口服DMDs到任何疾病活动的时间也较短（对数秩检验：p = 0.016；Cox比例风险分析：HR 2.18 [95% CI 1.14 - 4.19]，p = 0.019），短于非吸烟者。既往吸烟者和从不吸烟者组之间的复发及任何疾病活动的生存曲线无差异。多变量生存分析显示，在调整协变量后，当前吸烟是复发或任何疾病活动的独立风险因素（复发：HR 2.54 [95% CI 1.06 - 6.10]，p = 0.037；任何疾病活动：HR 3.47 [95% CI 1.27 - 9.50]，p = 0.015）。
吸烟是接受口服DMD治疗的RRMS患者疾病活动的风险因素。即使在开始使用DMDs后，也应建议RRMS患者戒烟。
