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Smoking is not significantly associated with disability progression in patients with multiple sclerosisSmoking and disability progression in multiple sclerosis patients

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Key Takeaway
Note that smoking was not significantly associated with disability progression or EDSS scores in this meta-analysis.

This meta-analysis investigated the impact of smoking on clinical outcomes in patients with multiple sclerosis. The study pooled data to evaluate several metrics, including disability progression, severity, and imaging markers.

The analysis found that smoking was not significantly associated with EDSS scores (SMD = 0.09; 95% CI [-0.04; 0.22]) or MSSS scores (SMD = 0.10; 95% CI [-0.15; 0.36]). Furthermore, smoking did not show a significant association with progression to EDSS ≥4 (HR = 1.27; 95% CI [0.90; 1.81]) or progression to EDSS ≥6 (HR = 1.20; 95% CI [0.65; 2.23]). Other outcomes, including T2 lesion volume and broadly defined disability progression (HR = 1.88; 95% CI [0.82; 4.32]), also showed no statistically significant association with smoking.

Limitations noted by the authors include high heterogeneity across several outcomes and an imprecise estimate for the broadly defined disability progression. While smoking was associated with trends toward worse clinical outcomes, these results did not reach statistical significance in the pooled analysis. Clinical application is limited by these inconsistencies and the lack of significant findings across the primary outcomes.

How this fits prior evidence

This meta-analysis addresses the impact of smoking on disability progression in multiple sclerosis. While it does not directly relate to the reported findings regarding slowly expanding lesions in 78% of patients, spinal cord lesions in 13.0% to 19.1% of stable patients, probiotic use for fatigue, vestibular rehabilitation for balance, or brain age gap as a cognitive marker, it provides data on the specific role of smoking in clinical progression.

Living with multiple sclerosis means managing a condition that can impact physical ability over time. One major question for patients and doctors is how lifestyle factors, like smoking, affect the speed at which physical disabilities progress. This study looked specifically at that link.

Researchers looked at several ways to measure disability and brain changes. They found that smoking was not significantly linked to standard disability scores or the size of certain lesions in the brain. While some trends suggested that smoking might be linked to worse outcomes, these results were not strong enough to be statistically certain.

Because the data was varied across different studies, some results were less precise than others. While the study did not find a clear, proven link between smoking and specific disability scores, it highlights how complex the relationship between lifestyle and disease progression can be.

What this means for you:
Smoking was not significantly linked to standard disability scores in patients with multiple sclerosis.

Common questions

Does smoking make multiple sclerosis worse?

The study looked at several ways to measure disability and brain changes. While there were some trends suggesting smoking might be linked to worse outcomes, the results were not statistically significant. This means the data did not show a clear, proven link between smoking and standard disability scores for people with multiple sclerosis.

How did they measure disability in this study?

Researchers used several different scales to measure disability and progress. These included the EDSS and MSSS scores, as well as looking at T2 lesion volume in the brain. In all of these specific measures, smoking was not significantly associated with the results.

Was the study's evidence very clear?

The evidence was somewhat mixed because the data was very different across the various studies included. For example, the estimate for broadly defined disability progression was not very precise. Because of this variety, the results are not definitive for every individual.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
BACKGROUND: Smoking is a well-established environmental risk factor for multiple sclerosis (MS), yet its impact on disability progression remains incompletely understood, with conflicting evidence across studies. OBJECTIVE: This review evaluated smoking and clinical outcomes in MS. Disability progression was the primary outcome; disability severity, imaging, relapse recovery, functional status, and patient-reported outcomes were secondary outcomes. METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Scopus, Web of Science, and the Cochrane Library were searched from inception through the 4th of March 2026. RESULTS: Eighteen studies were included. Smoking was not significantly associated with increased EDSS (SMD = 0.09, 95% CI [-0.04; 0.22]) or MSSS (SMD = 0.10, 95% CI [-0.15; 0.36]). Similarly, no significant associations were observed for progression to EDSS ≥4 (HR = 1.27, 95% CI [0.90; 1.81]) or EDSS ≥6 (HR = 1.20, 95% CI [0.65; 2.23]). T2 lesion volume was not significantly associated with smoking under the prespecified random-effects model. Broadly defined disability progression was not significantly associated with smoking, although the estimate was imprecise and heterogeneity was substantial (HR = 1.88, 95% CI [0.82; 4.32]). High heterogeneity was observed across several outcomes. Narrative findings suggested possible associations with poorer quality of life, greater fatigue, respiratory symptoms, and poorer relapse recovery, although these outcomes were heterogeneous and were not direct measures of longitudinal disability progression. CONCLUSION: Smoking was generally associated with trends toward worse clinical outcomes in multiple sclerosis; however, statistically significant effects were not consistently observed across pooled analysis.
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