Smoking cessation and multiple sclerosis
Project fact file
Professors Roshan dasNair and Cris Constantinescu
School / Division
Divisions of Psychiatry and Applied Psychology, and Clinical Neuroscience
Low cost research
Smoking is a major environmental risk factor for developing multiple sclerosis (MS), an inflammatory disease of the central nervous system. Smoking is associated with more severe and frequent relapses in relapsing-remitting MS. We have demonstrated that smoking accelerates progression of disability in progressive MS and in large part explains the increased mortality in MS. Our studies have shown that smoking cessation, even after the development of MS, reduces the progression of the disease, making it a worthwhile intervention even in more advanced stages. Recently, we provided estimates of effect and sample sizes for trials of smoking cessation in MS. However, the success rate of quitting is often problematic, in particular in people with long-term conditions. There have been very few intervention studies in chronic conditions, and no MS-specific cessation interventions have been published.
In the NHS, programmes such as NewLeaf are approved and trained advisors give short-term interventions. Switching to nicotine replacement or electronic cigarettes may be less difficult than total cessation. Although the benefits of such switch have not been assessed, it may be beneficial in MS, as, unlike smoking, chewing tobacco seems to be protective.
Therefore, a smoking cessation trial in MS is worth exploring, but its feasibility needs to be assessed, the barriers and facilitators of quitting identified, and potential outcome measures and biomarkers found.
We plan a mixed-methods (qualitative and quantitative) study to identify barriers and facilitators of smoking cessation; provide a standard small intervention programme combined with conversational analysis; and assess the effect of successful cessation on biomarkers with relevance to MS pathology. These studies will inform a large multicentre interventional trial in terms of feasibility, optimal intervention, anticipated effect size, participant numbers, outcome measures and surrogates of beneficial biological effect. They will also provide conversational tools to be applied in routine NHS practice by healthcare providers in their communication with MS patients.
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