Effect of smoking on disease activity in multiple sclerosis patients treated with dimethyl fumarate or fingolimod
Effect of smoking on disease activity in multiple sclerosis patients treated with dimethyl fumarate or fingolimod
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吸烟对接受富马酸二甲酯或芬戈莫德治疗的多发性硬化症患者疾病活动度的影响
DOI：
10.1016/j.msard.2023.104513
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Isobe N
中科院分区：
文献类型：
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作者：
Tanaka E;Watanabe M;Fukumoto S;Masaki K;Yamasaki R;Matsushita T;Isobe N
背景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危险因素。然而，其对口服疾病缓解药物（DMD）疗效的影响尚不清楚。因此，我们启动了一项单中心、回顾性、观察性研究，以调查RRMS患者在口服DMDs.MethodsWe下吸烟与疾病活动之间的关系，回顾性招募了2012年1月至2019年12月期间在我院启动口服DMDs（芬戈莫德或富马酸二甲酯）的RRMS患者。收集了截至2020年12月口服DMD启动时的临床数据和吸烟状况。我们进行了生存分析复发和任何疾病的活动，定义为复发或MRI疾病活动，在不同的吸烟status.ResultsWe纳入103 RRMS患者口服DMD，包括19（18.4%）目前吸烟者在基线。与非吸烟者相比，当前吸烟者随访期间复发和任何疾病活动的比例较高（复发：p= 0.040，任何疾病活动：p= 0.004），当前吸烟者从开始口服DMD到复发的时间较短（对数秩检验：p= 0.011;考克斯比例风险分析：风险比（HR）2.72 [95%置信区间（CI）1.22-6.09]，p= 0.015）。当前吸烟者从开始口服DMD到任何疾病活动的时间也短于非吸烟者（对数秩检验：p= 0.016;考克斯比例风险分析：HR 2.18 [95% CI 1.14-4.19]，p= 0.019）。复发和任何疾病活动的生存曲线在前吸烟者和从不吸烟者组之间没有差异。多变量生存分析显示，在调整协变量后，目前吸烟是复发或任何疾病活动的独立危险因素（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）。结论吸烟是RRMS患者口服DMD治疗后疾病活动的危险因素。RRMS患者应被告知即使在DMD开始后也要戒烟。
BackgroundIn 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.MethodsWe 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.ResultsWe 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).ConclusionSmoking 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.