SynthesisNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2026
Smoking and disability outcomes in multiple sclerosis: a systematic review and meta-analysis.
Synthesis in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
8 authors.
Funding
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Abstract
backgroundSmoking 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.
objectiveThis 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.
methodsA 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.
resultsEighteen 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.
conclusionSmoking 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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