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Main outcomes were Expanded Disability Status Scale (EDSS), Timed 25-Foot Walk (T25FW) and Paced Auditory Serial Addition Test (PASAT). Secondary outcomes were number of T2 and GD+ lesions. We conducted logistic and linear mixed model regression, adjusted for age, sex, educational level, MS subtype.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Smoking cigarettes was associated with increased odds of reaching pre-defined cut-off values for EDSS and T25FW, as well as with increased mean differences across follow-ups. Alcohol consumption was associated with decreased odds of reaching the cut-off for EDSS and T25FW. Findings for PASAT were less consistent. We found no significant associations for T2 and GD+ lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This study provides further evidence that smoking cigarettes accelerates MS progression and that pwMS should be advised to quit smoking. However, this negative impact could not be demonstrated for alcohol consumption. Reverse causation cannot be ruled out and further research in this area is warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration:<\/jats:title>\n                    <jats:p>\n                      Instead of registration in a primary trial registry, a comprehensive study protocol was published a priori and is available online:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/osf.io\/3xscy\">https:\/\/osf.io\/3xscy<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17562864261464304","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T16:19:19Z","timestamp":1785341959000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of tobacco and alcohol consumption on disease progression and MRI in people with multiple sclerosis: results of the prospective cohort study NationMS"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0484-1718","authenticated-orcid":false,"given":"Alex Maximilian","family":"Keller","sequence":"first","affiliation":[{"name":"Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Martinistra\u00dfe 52, Hamburg DE-20246, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"M\u00f6hl","sequence":"additional","affiliation":[{"name":"University Medical Center Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4751-299X","authenticated-orcid":false,"given":"Anke","family":"Salmen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ruhr-Universit\u00e4t Bochum, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Gold","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ruhr-Universit\u00e4t Bochum, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Renk","sequence":"additional","affiliation":[{"name":"Department of Neurology, Ruhr-Universit\u00e4t Bochum, Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5439-9633","authenticated-orcid":false,"given":"Luisa","family":"Klotz","sequence":"additional","affiliation":[{"name":"Department of Neurology with Institute of Translational Neurology, Medical Faculty, University Hospital M\u00fcnster, M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2179-3655","authenticated-orcid":false,"given":"Stefan","family":"Bittner","sequence":"additional","affiliation":[{"name":"Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), Johannes Gutenberg University Hospital Mainz, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3293-5121","authenticated-orcid":false,"given":"Vinzenz","family":"Fleischer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Research Center for Immunotherapy (FZI) and Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2)"},{"name":"Johannes Gutenberg University Hospital Mainz, Mainz, 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