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Cox regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for 24-week confirmed disability worsening (CDW) and time to Expanded Disability Status Scale (EDSS) 3, 4, and 6. Interaction was assessed on the additive scale.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Compared with\n                      <jats:italic toggle=\"yes\">HLA-A*02:01<\/jats:italic>\n                      -positive non-smokers, smoking at diagnosis was associated with a higher risk of disability progression primarily among individuals who lacked\n                      <jats:italic toggle=\"yes\">HLA-A*02:01<\/jats:italic>\n                      , with consistently elevated risks of CDW (HR\u2009=\u20091.15, 95% CI\u2009=\u20091.06\u20131.26), EDSS 3 (HR\u2009=\u20091.26, 95% CI\u2009=\u20091.08\u20131.47), and EDSS 4 (HR\u2009=\u20091.50, 95% CI\u2009=\u20091.25\u20131.79). No clear effect of smoking was observed among\n                      <jats:italic toggle=\"yes\">HLA-A*02:01<\/jats:italic>\n                      carriers, and no evidence of interaction was detected between smoking and\n                      <jats:italic toggle=\"yes\">HLA-DRB1*15:01<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>These findings suggest that the impact of smoking on MS progression varies according to immunogenetic background.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13524585261453243","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T17:22:36Z","timestamp":1783099356000},"page":"962-971","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Interaction between smoking and\n                    <i>HLA-A*02:01<\/i>\n                    in multiple sclerosis progression"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6612-4749","authenticated-orcid":false,"given":"Anna Karin","family":"Hedstr\u00f6m","sequence":"first","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4855-0039","authenticated-orcid":false,"given":"Pernilla","family":"Stridh","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7386-6732","authenticated-orcid":false,"given":"Jan","family":"Hillert","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas","family":"Olsson","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Alfredsson","sequence":"additional","affiliation":[{"name":"Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2016.187"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1212676"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-025-01212-1"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2019.4271"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awt139"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1080\/14737175.2020.1743176"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2022-330848"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-023-06250-x"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awac092"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/1352458518801727"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2020-325676"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30470-2"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awab385"},{"key":"e_1_3_2_15_2","article-title":"Multiple sclerosis genomic map implicates peripheral immune cells and microglia in susceptibility","volume":"365","author":"Patsopoulos NA","year":"2019","unstructured":"Patsopoulos NA, Baranzini SE, Santaniello A, et al. Multiple sclerosis genomic map implicates peripheral immune cells and microglia in susceptibility. Science 2019; 365: eaav7188.","journal-title":"Science"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pcbi.1002877"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-025-01276-z"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-005-7835-x"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awae110"},{"key":"e_1_3_2_20_2","article-title":"Systemic inflammation in progressive multiple sclerosis involves follicular T-helper, Th17- and activated B-cells and correlates with progression","volume":"8","author":"Romme Christernsen J","year":"2013","unstructured":"Romme Christernsen J, B\u00f6rnsen L, Ratzer R, et al. Systemic inflammation in progressive multiple sclerosis involves follicular T-helper, Th17- and activated B-cells and correlates with progression. 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