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Tulloch HE, Pipe AL, Els C, Clyde MJ, Reid RD. Flexible, dual-form nicotine replacement therapy or varenicline in comparison with nicotine patch for smoking cessation: a randomized controlled trial. BMC Med 2016; 14:80. [PMID: 27233840 PMCID: PMC4884360 DOI: 10.1186/s12916-016-0626-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 05/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extended use of combined pharmacotherapies to treat tobacco dependence may increase smoking abstinence; few studies have examined their effectiveness. The objective of this study was to evaluate smoking abstinence with standard nicotine patch (NRT), extended use of combined formulations of nicotine replacement therapy (NRT+), or varenicline (VR). METHODS A total of 737 smokers, including those with medical and psychiatric comorbidities, were randomly assigned to one of the above three treatment conditions. The NRT group received 10 weeks of patches (21 mg daily maximum); the NRT+ group received patches (35 mg daily maximum) and gum or inhaler for up to 22 weeks; and the VR group received 1 mg twice daily for up to 24 weeks (22 weeks post target quit date). All participants also received six standardized 15-minute smoking cessation counseling sessions by nurses experienced in tobacco dependence treatment. The primary outcome was carbon monoxide-confirmed continuous abstinence rates (CAR) from weeks 5-52. Secondary outcomes were: CAR from weeks 5-10 and 5-22, and carbon monoxide-confirmed 7-day point prevalence (7PP) at weeks 10, 22, and 52. Adjusted and unadjusted logistic regression analyses were conducted using intention-to-treat procedures. RESULTS The CARs for weeks 5-52 were 10.0 %, 12.4 %, and 15.3 % in the NRT, NRT+, and VR groups, respectively; no group differences were observed. Results with 7PP showed that VR was superior to NRT at week 52 (odds ratio (OR), 1.84; 97.5 % Confidence Interval (CI), 1.04-3.26) in the adjusted intention-to-treat analysis. Those in the VR group had higher CAR at weeks 5-22 (OR, 2.01; CI, 1.20-3.36) than those in the NRT group. Results with 7PP revealed that both NRT+ (OR, 1.72; CI, 1.04-2.85) and VR (OR, 1.96; CI, 1.20-3.23) were more effective than NRT at 22 weeks. As compared to NRT monotherapy, NRT+ and VR produced significant increases in CAR for weeks 5-10 (OR, 1.52; CI, 1.00-2.30 and OR, 1.58; CI, 1.04-2.39, respectively); results were similar, but somewhat stronger, when 7PP was used at 10 weeks (OR, 1.57; CI, 1.03-2.41 and OR, 1.79; CI, 1.17-2.73, respectively). All medications were well tolerated, but participants in the VR group experienced more fatigue, digestive symptoms (e.g., nausea, diarrhea), and sleep-related concerns (e.g., abnormal dreams, insomnia), but less dermatologic symptoms than those in the NRT or NRT+ groups. The frequency of serious adverse events did not differ between groups. CONCLUSIONS Flexible and combination NRT and varenicline enhance success in the early phases of quitting. Varenicline improves abstinence in the medium term; however, there is no clear evidence that either varenicline or flexible, dual-form NRT increase quit rates in the long-term when compared to NRT monotherapy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01623505 ; Retrospectively registered on July 13, 2011.
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Affiliation(s)
- Heather E Tulloch
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4 W7, Canada. .,Faculty of Medicine, University of Ottawa, Ottawa, Canada. .,School of Psychology, University of Ottawa, Ottawa, Canada.
| | - Andrew L Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4 W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Charl Els
- Department of Psychiatry, 1E1 Walter Mackenzie Health Sciences Centre, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Matthew J Clyde
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4 W7, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
| | - Robert D Reid
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4 W7, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Cahill K, Lindson‐Hawley N, Thomas KH, Fanshawe TR, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev 2016; 2016:CD006103. [PMID: 27158893 PMCID: PMC6464943 DOI: 10.1002/14651858.cd006103.pub7] [Citation(s) in RCA: 190] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nicotine receptor partial agonists may help people to stop smoking by a combination of maintaining moderate levels of dopamine to counteract withdrawal symptoms (acting as an agonist) and reducing smoking satisfaction (acting as an antagonist). OBJECTIVES To review the efficacy of nicotine receptor partial agonists, including varenicline and cytisine, for smoking cessation. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's specialised register for trials, using the terms ('cytisine' or 'Tabex' or 'dianicline' or 'varenicline' or 'nicotine receptor partial agonist') in the title or abstract, or as keywords. The register is compiled from searches of MEDLINE, EMBASE, and PsycINFO using MeSH terms and free text to identify controlled trials of interventions for smoking cessation and prevention. We contacted authors of trial reports for additional information where necessary. The latest update of the specialised register was in May 2015, although we have included a few key trials published after this date. We also searched online clinical trials registers. SELECTION CRITERIA We included randomised controlled trials which compared the treatment drug with placebo. We also included comparisons with bupropion and nicotine patches where available. We excluded trials which did not report a minimum follow-up period of six months from start of treatment. DATA COLLECTION AND ANALYSIS We extracted data on the type of participants, the dose and duration of treatment, the outcome measures, the randomisation procedure, concealment of allocation, and completeness of follow-up.The main outcome measured was abstinence from smoking at longest follow-up. We used the most rigorous definition of abstinence, and preferred biochemically validated rates where they were reported. Where appropriate we pooled risk ratios (RRs), using the Mantel-Haenszel fixed-effect model. MAIN RESULTS Two trials of cytisine (937 people) found that more participants taking cytisine stopped smoking compared with placebo at longest follow-up, with a pooled risk ratio (RR) of 3.98 (95% confidence interval (CI) 2.01 to 7.87; low-quality evidence). One recent trial comparing cytisine with NRT in 1310 people found a benefit for cytisine at six months (RR 1.43, 95% CI 1.13 to 1.80).One trial of dianicline (602 people) failed to find evidence that it was effective (RR 1.20, 95% CI 0.82 to 1.75). This drug is no longer in development.We identified 39 trials that tested varenicline, 27 of which contributed to the primary analysis (varenicline versus placebo). Five of these trials also included a bupropion treatment arm. Eight trials compared varenicline with nicotine replacement therapy (NRT). Nine studies tested variations in varenicline dosage, and 13 tested usage in disease-specific subgroups of patients. The included studies covered 25,290 participants, 11,801 of whom used varenicline.The pooled RR for continuous or sustained abstinence at six months or longer for varenicline at standard dosage versus placebo was 2.24 (95% CI 2.06 to 2.43; 27 trials, 12,625 people; high-quality evidence). Varenicline at lower or variable doses was also shown to be effective, with an RR of 2.08 (95% CI 1.56 to 2.78; 4 trials, 1266 people). The pooled RR for varenicline versus bupropion at six months was 1.39 (95% CI 1.25 to 1.54; 5 trials, 5877 people; high-quality evidence). The RR for varenicline versus NRT for abstinence at 24 weeks was 1.25 (95% CI 1.14 to 1.37; 8 trials, 6264 people; moderate-quality evidence). Four trials which tested the use of varenicline beyond the 12-week standard regimen found the drug to be well-tolerated during long-term use. The number needed to treat with varenicline for an additional beneficial outcome, based on the weighted mean control rate, is 11 (95% CI 9 to 13). The most commonly reported adverse effect of varenicline was nausea, which was mostly at mild to moderate levels and usually subsided over time. Our analysis of reported serious adverse events occurring during or after active treatment suggests there may be a 25% increase in the chance of SAEs among people using varenicline (RR 1.25; 95% CI 1.04 to 1.49; 29 trials, 15,370 people; high-quality evidence). These events include comorbidities such as infections, cancers and injuries, and most were considered by the trialists to be unrelated to the treatments. There is also evidence of higher losses to follow-up in the control groups compared with the intervention groups, leading to a likely underascertainment of the true rate of SAEs among the controls. Early concerns about a possible association between varenicline and depressed mood, agitation, and suicidal behaviour or ideation led to the addition of a boxed warning to the labelling in 2008. However, subsequent observational cohort studies and meta-analyses have not confirmed these fears, and the findings of the EAGLES trial do not support a causal link between varenicline and neuropsychiatric disorders, including suicidal ideation and suicidal behaviour. The evidence is not conclusive, however, in people with past or current psychiatric disorders. Concerns have also been raised that varenicline may slightly increase cardiovascular events in people already at increased risk of those illnesses. Current evidence neither supports nor refutes such an association, but we await the findings of the CATS trial, which should establish whether or not this is a valid concern. AUTHORS' CONCLUSIONS Cytisine increases the chances of quitting, although absolute quit rates were modest in two recent trials. Varenicline at standard dose increased the chances of successful long-term smoking cessation between two- and three-fold compared with pharmacologically unassisted quit attempts. Lower dose regimens also conferred benefits for cessation, while reducing the incidence of adverse events. More participants quit successfully with varenicline than with bupropion or with NRT. Limited evidence suggests that varenicline may have a role to play in relapse prevention. The most frequently recorded adverse effect of varenicline is nausea, but mostly at mild to moderate levels and tending to subside over time. Early reports of possible links to suicidal ideation and behaviour have not been confirmed by current research.Future trials of cytisine may test extended regimens and more intensive behavioural support.
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Affiliation(s)
- Kate Cahill
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Nicola Lindson‐Hawley
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Kyla H Thomas
- University of BristolSchool of Social and Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Thomas R Fanshawe
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Tim Lancaster
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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Penberthy JK, Penberthy JM, Harris MR, Nanda S, Ahn J, Martinez CP, Osika AO, Slepian ZA, Forsyth JC, Starr JA, Farrell JE, Hook JN. Are Smoking Cessation Treatments Associated with Suicidality Risk? An Overview. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2016; 10:19-30. [PMID: 27081311 PMCID: PMC4830638 DOI: 10.4137/sart.s33389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 12/29/2022]
Abstract
Risk of suicidality during smoking cessation treatment is an important, but often overlooked, aspect of nicotine addiction research and treatment. We explore the relationship between smoking cessation interventions and suicidality and explore common treatments, their associated risks, and effectiveness in promoting smoking reduction and abstinence. Although active smokers have been reported to have twofold to threefold increased risk of suicidality when compared to nonsmokers,1–4 research regarding the safest way to stop smoking does not always provide clear guidelines for practitioners wishing to advise their patients regarding smoking cessation strategies. In this article, we review pharmacological and cognitive behavioral therapy (CBT) options that are available for people seeking to quit smoking, focusing on the relationship between the ability of these therapies to reduce smoking behavior and promote abstinence and suicidality risks as assessed by reported suicidality on validated measures, reports of suicidal ideation, behaviors, actual attempts, or completed suicides. Pharmacotherapies such as varenicline, bupropion, and nicotine replacement, and CBTs, including contextual CBT interventions, have been found to help reduce smoking rates and promote and maintain abstinence. Suicidality risks, while present when trying to quit smoking, do not appear to demonstrate a consistent or significant rise associated with use of any particular smoking cessation pharmacotherapy or CBT/contextual CBT intervention reviewed.
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Affiliation(s)
- J Kim Penberthy
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - J Morgan Penberthy
- Department of Psychology, Wake Forest University, Winston-Salem, NC, USA
| | - Marcus R Harris
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Sonali Nanda
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jennifer Ahn
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Caridad Ponce Martinez
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Apule O Osika
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Zoe A Slepian
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - J Andrew Starr
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Joshua N Hook
- Department of Psychology, University of North Texas, Denton, TX, USA
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Cardiovascular Safety Warnings and the Prescribing of Varenicline: An Interrupted Time-series Analysis. Epidemiology 2016; 27:e28-9. [PMID: 27046129 DOI: 10.1097/ede.0000000000000492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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55
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Burke MV, Hays JT, Ebbert JO. Varenicline for smoking cessation: a narrative review of efficacy, adverse effects, use in at-risk populations, and adherence. Patient Prefer Adherence 2016; 10:435-41. [PMID: 27099479 PMCID: PMC4824380 DOI: 10.2147/ppa.s83469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Treating tobacco dependence is the most effective way to reduce tobacco-related death and disability. Counseling and pharmacotherapy have been shown to increase tobacco abstinence rates among smokers. Varenicline is the most effective monotherapy treatment for tobacco dependence; however, it is prescribed less often than indicated, and adherence is less than optimal. We conducted a literature review of the development, efficacy, safety, contraindications, and adverse effects of varenicline; including reviewing data regarding combination therapy, extended duration, and patient adherence. Varenicline was developed to work specifically on the factors that underlie nicotine addiction. Phase II and Phase III trials established dosing, safety profiles, and efficacy. Postmarketing research raised concerns about neuropsychiatric and cardiac effects, resulting in warning labels being added and modified to encourage discussions with patients weighing the risks and benefits. While more research is needed, evidence is strong that varenicline is safe and effective in treating tobacco dependence among people who are at higher risk for neuropsychiatric symptoms and cardiovascular disease. The effectiveness of varenicline can be improved by taking it in combination with other medications, enhancing patient adherence and extending the duration of treatment.
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56
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Sterling LH, Windle SB, Filion KB, Touma L, Eisenberg MJ. Varenicline and Adverse Cardiovascular Events: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 2016; 5:JAHA.115.002849. [PMID: 26903004 PMCID: PMC4802486 DOI: 10.1161/jaha.115.002849] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Varenicline is an efficacious smoking‐cessation drug. However, previous meta‐analyses provide conflicting results regarding its cardiovascular safety. The publication of several new randomized controlled trials (RCTs) provides an opportunity to reassess this potential adverse drug reaction. Methods and Results We searched MEDLINE, EMBASE, and the Cochrane Library for RCTs that compare varenicline with placebo for smoking cessation. RCTs reporting cardiovascular serious adverse events and/or all‐cause mortality during the treatment period or within 30 days of treatment discontinuation were eligible for inclusion. Relative risks (RRs) with 95% CIs were generated by using DerSimonian–Laird random‐effects models. Thirty‐eight RCTs met our inclusion criteria (N=12 706). Events were rare in both varenicline (57/7213) and placebo (43/5493) arms. No difference was observed for cardiovascular serious adverse events when comparing varenicline with placebo (RR 1.03, 95% CI 0.72–1.49). Similar findings were obtained when examining cardiovascular (RR 1.04, 95% CI 0.57–1.89) and noncardiovascular patients (RR 1.03, 95% CI 0.64–1.64). Deaths were rare in both varenicline (11/7213) and placebo (9/5493) arms. Although 95% CIs were wide, pooling of all‐cause mortality found no difference between groups (RR 0.88, 95% CI 0.50–1.52), including when stratified by participants with (RR 1.24, 95% CI 0.40–3.83) and without (RR 0.77, 95% CI 0.40–1.48) cardiovascular disease. Conclusions We found no evidence that varenicline increases the rate of cardiovascular serious adverse events. Results were similar among those with and without cardiovascular disease. Given varenicline's efficacy as a smoking cessation drug and the long‐term cardiovascular benefits of cessation, it should continue to be prescribed for smoking cessation.
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Affiliation(s)
- Lee H Sterling
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sarah B Windle
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada
| | - Kristian B Filion
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada Faculty of Medicine, McGill University, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Lahoud Touma
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Mark J Eisenberg
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada Division of Cardiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada Faculty of Medicine, McGill University, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Rojewski AM, Baldassarri S, Cooperman NA, Gritz ER, Leone FT, Piper ME, Toll BA, Warren GW. Exploring Issues of Comorbid Conditions in People Who Smoke. Nicotine Tob Res 2016; 18:1684-96. [PMID: 26783291 DOI: 10.1093/ntr/ntw016] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 01/06/2016] [Indexed: 01/21/2023]
Abstract
UNLABELLED Smoking affects comorbid disease outcomes, and patients with comorbid conditions may have unique characteristics that are important to consider when treating tobacco use. However, addressing tobacco in patients being treated for comorbid conditions is not a consistent practice. Recognizing the need for a "call-to-action" to address tobacco use in people with comorbid conditions, the Tobacco Treatment Network within the Society for Research on Nicotine and Tobacco (SRNT) convened a Comorbidities Workgroup to explore the relationship between smoking and comorbid disease to identify common themes including: the harms associated with continued tobacco use, the frequency of comorbid disease and tobacco use, the potential effect of comorbid disease on the ability to quit tobacco use, the association between tobacco use and suboptimal disease-specific treatment response, and evidence regarding potential approaches to improve addressing tobacco use in patients with comorbid disease. Five candidate conditions (psychiatric, cancer, cardiovascular, pulmonary, and human immunodeficiency virus infected patients) were explored. Across comorbid conditions, smoking adversely affects treatment efficacy and promotes other adverse health conditions. People with comorbid conditions who smoke are motivated to quit and respond to evidence-based smoking cessation treatments. However, tobacco cessation is not regularly incorporated into the clinical care of many individuals with comorbidities. Optimal strategies for addressing tobacco use within each comorbid disease are also not well defined. Further work is needed to disseminate evidence-based care into clinical practice for smokers with comorbid disease and addiction research should consider comorbid conditions as an important construct to explore. IMPLICATIONS This article explores how physical and psychiatric conditions may interact in the treatment of tobacco dependence, and discusses the need for smoking cessation as a critical component of comorbid condition management. Five common comorbid domains-psychiatric, cancer, pulmonary, cardiovascular, and human immunodeficiency virus (HIV)-are highlighted to illustrate how these different conditions might interact with smoking with respect to prevalence and harm, motivation to quit, and cessation treatment utilization and success.
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Affiliation(s)
- Alana M Rojewski
- Department of Psychiatry, Yale School of Medicine, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Stephen Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
| | - Nina A Cooperman
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Ellen R Gritz
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Frank T Leone
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Presbyterian Medical Center, Philadelphia, PA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Benjamin A Toll
- Department of Psychiatry, Yale School of Medicine, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC; Department of Cancer Prevention and Control, Yale Cancer Center, New Haven, CT; Tobacco Treatment Service, Smilow Cancer Hospital at Yale-New Haven, New Haven, CT; Tobacco Treatment and Lung Cancer Screening Programs, Hollings Cancer Center, Charleston, SC
| | - Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC; Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC
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Eisenberg MJ, Windle SB, Roy N, Old W, Grondin FR, Bata I, Iskander A, Lauzon C, Srivastava N, Clarke A, Cassavar D, Dion D, Haught H, Mehta SR, Baril JF, Lambert C, Madan M, Abramson BL, Dehghani P. Varenicline for Smoking Cessation in Hospitalized Patients With Acute Coronary Syndrome. Circulation 2016; 133:21-30. [DOI: 10.1161/circulationaha.115.019634] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 10/19/2015] [Indexed: 11/16/2022]
Abstract
Background—
Less than one-third of smokers hospitalized with an acute coronary syndrome (ACS) remain abstinent following discharge. We assessed whether varenicline, begun in-hospital, is efficacious for smoking cessation following ACS.
Methods and Results—
We conducted a multi-center, double-blind, randomized, placebo-controlled trial in which smokers hospitalized with an ACS were randomized to varenicline or placebo for 12 weeks. All patients received low-intensity counseling. The primary end point was point-prevalence smoking abstinence assessed at 24 weeks by 7-day recall and biochemical validation using expired carbon monoxide. A total of 302 patients were randomized (mean age 55±9 years; 75% male; 56% ST-segment elevation myocardial infarction; 38% non-ST-segment elevation myocardial infarction; 6% unstable angina). Patients smoked a mean of 21±11 cigarettes/d at the time of hospitalization and had been smoking for a mean of 36±12 years. At 24 weeks, patients randomized to varenicline had significantly higher rates of smoking abstinence and reduction than patients randomized to placebo. Point-prevalence abstinence rates were 47.3% in the varenicline group and 32.5% in the placebo group (
P
=0.012; number needed to treat=6.8). Continuous abstinence rates were 35.8% and 25.8%, respectively (
P
=0.081; number needed to treat=10.0), and rates of reduction ≥50% in daily cigarette consumption were 67.4% and 55.6%, respectively (
P
=0.05; number needed to treat=8.5). Adverse event rates within 30 days of study drug discontinuation were similar between groups (serious adverse events: varenicline 11.9%, placebo 11.3%; major adverse cardiovascular events: varenicline 4.0%, placebo 4.6%).
Conclusions—
Varenicline, initiated in-hospital following ACS, is efficacious for smoking cessation. Future studies are needed to establish safety in these patients.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00794573.
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Affiliation(s)
- Mark J. Eisenberg
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Sarah B. Windle
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Nathalie Roy
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Wayne Old
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - François R. Grondin
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Iqbal Bata
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Ayman Iskander
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Claude Lauzon
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Nalin Srivastava
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Adam Clarke
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Daniel Cassavar
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Danielle Dion
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Herbert Haught
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Shamir R. Mehta
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Jean-François Baril
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Charles Lambert
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Mina Madan
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Beth L. Abramson
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
| | - Payam Dehghani
- From Jewish General Hospital/McGill University, Montréal, QC, Canada (M.J.E., S.B.W.); Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada (N.R.); Sentara Cardiovascular Research Institute, Norfolk, VA (W.O.); CISSS Chaudière-Appalaches, Hôtel-Dieu de Lévis site, QC, Canada (F.R.G.); Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (I.B.); SJH Cardiology Associates and St. Joseph’s Hospital, Liverpool, NY (A.I.); CISSS - Chaudière-Appalaches, Thetford Mines, QC
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Silva AP, Scholz J, Abe TO, Pinheiro GG, Gaya PV, Pereira AC, Santos PCJL. Influence of smoking cessation drugs on blood pressure and heart rate in patients with cardiovascular disease or high risk score: real life setting. BMC Cardiovasc Disord 2016; 16:2. [PMID: 26728720 PMCID: PMC4700597 DOI: 10.1186/s12872-015-0180-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 12/21/2015] [Indexed: 11/14/2022] Open
Abstract
Background Smoking is the most important reversible cardiovascular risk factor. It is well established that quitting smoking reduces coronary events. However, on several occasions, the cardiovascular safety of smoking cessation drugs has been questioned. Our goal is to evaluate the effects of smoking cessation drugs on blood pressure and heart rate in patients from a smoking cessation service in a cardiology hospital. Methods We examined the PAF database (Smoking Cessation Assistance Program database) between January 2008 and March 2014. We analyzed data from 900 patients who were compliant with the treatment (50.5 % male, average age 53 ± 17 years). The most frequent clinical diagnoses were coronary artery disease (25.2 %), hypertension (57.2 %), and diabetes (13.4 %). Blood pressure, heart rate, and carbon monoxide (CO) concentration in exhaled air were analyzed at consecutive visits during the first 45 days of treatment (mean visits - 3). Analysis of repeated measures was used for the statistical analysis (p < 0.05). Results Two hundred seventy one patients used nicotine replacement therapy (NRT) alone, 81 used bupropion alone, 154 used varenicline alone, 283 used NRT plus bupropion and 111 used bupropion plus varenicline. For all smoking cessation drugs, used alone or in combination, no increase occurred in the average value of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR). Significant reductions in CO concentrations occurred in all smoking cessation drug groups. Conclusion Smoking cessation drugs used in monotherapy or in combined regimens did not influence systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) in this group of patients during the observation period.
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Affiliation(s)
| | - Jaqueline Scholz
- Smoking Cessation Program Department, Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar 44, Cerqueira Cesar, 05403-900, Sao Paulo, SP, Brazil.
| | - Tania Ogawa Abe
- Smoking Cessation Program Department, Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar 44, Cerqueira Cesar, 05403-900, Sao Paulo, SP, Brazil
| | | | | | - Alexandre Costa Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Paulo Caleb Junior Lima Santos
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
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Treating Tobacco Use in Clinical Practice. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cardiovascular and neuropsychiatric risks of varenicline: too good to be true? - Authors' reply. THE LANCET RESPIRATORY MEDICINE 2015; 3:e40-2. [PMID: 26679028 DOI: 10.1016/s2213-2600(15)00470-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 10/28/2015] [Indexed: 11/20/2022]
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Nielen JTH, Burden AM. Cardiovascular and neuropsychiatric risks of varenicline: too good to be true? THE LANCET RESPIRATORY MEDICINE 2015; 3:e38-9. [PMID: 26679025 DOI: 10.1016/s2213-2600(15)00467-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/28/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Johannes T H Nielen
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands; Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, Netherlands.
| | - Andrea M Burden
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands; Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, Netherlands
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63
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Aubin HJ, Luquiens A. Feeding Two Birds with One Scone: The Case of Varenicline. Alcohol Clin Exp Res 2015; 39:2299-301. [DOI: 10.1111/acer.12907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/15/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Henri-Jean Aubin
- Paul-Brousse Hospital; AP-HP; Inserm U 1178; Paris-Sud University; Villejuif France
| | - Amandine Luquiens
- Paul-Brousse Hospital; AP-HP; Inserm U 1178; Paris-Sud University; Villejuif France
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Davies NM, Taylor G, Taylor AE, Thomas KH, Windmeijer F, Martin RM, Munafò MR. What are the effects of varenicline compared with nicotine replacement therapy on long-term smoking cessation and clinically important outcomes? Protocol for a prospective cohort study. BMJ Open 2015; 5:e009665. [PMID: 26546148 PMCID: PMC4636632 DOI: 10.1136/bmjopen-2015-009665] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Smoking is a major avoidable cause of ill-health and premature death. Treatments that help patients successfully quit smoking have an important effect on health and life expectancy. Varenicline is a medication that can help smokers successfully quit smoking. However, there are concerns that it may cause adverse effects, such as increase in the occurrence of depression, self-harm and suicide and cardiovascular disease. In this study we aim to examine the effects of varenicline versus other smoking cessation pharmacotherapies on smoking cessation, health service use, all-cause and cause-specific mortality and physical and mental health conditions. METHODS In this project we will investigate the effects of varenicline compared to nicotine replacement therapies on: (1) long-term smoking cessation and whether these effects differ by area level deprivation; and (2) the following clinically-important outcomes: rate of general practice and hospital attendance; all-cause mortality and death due to diseases of the respiratory system and cardiovascular disease; and a primary care diagnosis of respiratory illness, myocardial infarction or depression and anxiety. The study is based on a cohort of patients prescribed these smoking cessation medications from the Clinical Practice Research Datalink (CPRD). We will use three methods to overcome confounding: multivariable adjusted Cox regression, propensity score matched Cox regression, and instrumental variable regression. The total expected sample size for analysis will be at least 180,000. Follow-up will end with the earliest of either an 'event' or censoring due to the end of registration or death. ETHICS AND DISSEMINATION Ethics approval was not required for this study. This project has been approved by the CPRD's Independent Scientific Advisory Committee (ISAC). We will disseminate our findings via publications in international peer-reviewed journals and presentations at international conferences.
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Affiliation(s)
- Neil M Davies
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Gemma Taylor
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Amy E Taylor
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Kyla H Thomas
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Frank Windmeijer
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Economics, University of Bristol, Bristol, UK
| | - Richard M Martin
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Marcus R Munafò
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Experimental Psychology, University of Bristol, Bristol, UK
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Sohrab SS, Bhattacharya P, Rana D, Kamal MA, Pande M. Development of interspecific Solanum lycopersicum and screening for Tospovirus resistance. Saudi J Biol Sci 2015; 22:730-8. [PMID: 26587001 PMCID: PMC4625138 DOI: 10.1016/j.sjbs.2014.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/25/2014] [Accepted: 11/07/2014] [Indexed: 12/04/2022] Open
Abstract
Tospovirus has emerged as a serious viral pathogen for several crops including tomato. The tomato production is being severely affected worldwide by Tospovirus. Some reports have been published about the association of plant virus and development of human disease either by direct or indirect consumption. Resistance to this virus has been identified as good source in wild tomato species (Lycopersicum peruvianum). But the introgression of resistance genes into cultivated tomato lines and the development of interspecific hybrid are hampered due to incompatibility, fertilization barriers and embryo abortion. But this barrier has been broken by applying the embryo rescue methods. This study describes the development of interspecific hybrid tomato plants by highly efficient embryo rescue method and screening for Tospovirus resistance. The interspecific hybrid tomato plants were developed by making a cross between wild tomato species (L. peruvianum) and cultivated tomato (Solanum lycopersicum). The immature embryos were cultured in standardized medium and interspecific hybrids were developed from embryogenic callus. The immature embryos excised from 7 to 35 days old fruits were used for embryo rescue and 31 days old embryos showed very good germination capabilities and produced the highest number of plants. Developed plants were hardened enough and shifted to green house. The hybrid nature of interspecific plants was further confirmed by comparing the morphological characters from their parents. The F1, F2 and F3 plants were found to have varying characters especially for leaf type, color of stem, fruits, size, shapes and they were further screened for virus resistance both in lab and open field followed by Enzyme linked Immunosorbant Assay confirmation. Finally, a total of 11 resistant plants were selected bearing red color fruits with desired shape and size.
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Affiliation(s)
- Sayed Sartaj Sohrab
- King Fahd Medical Research Center, King Abdulaziz University, Post Box No. 80216, Jeddah 21589, Saudi Arabia
| | - P.S. Bhattacharya
- Division of Biotechnology, JK Agri-Genetics Ltd., Hyderabad, A.P., India
| | - D. Rana
- Division of Biotechnology, JK Agri-Genetics Ltd., Hyderabad, A.P., India
| | - Mohammad A. Kamal
- King Fahd Medical Research Center, King Abdulaziz University, Post Box No. 80216, Jeddah 21589, Saudi Arabia
| | - M.K. Pande
- Division of Biotechnology, JK Agri-Genetics Ltd., Hyderabad, A.P., India
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Selçuk EB, Sungu M, Parlakpinar H, Ermiş N, Taslıdere E, Vardı N, Yalçınsoy M, Sagır M, Polat A, Karatas M, Kayhan-Tetik B. Evaluation of the cardiovascular effects of varenicline in rats. Drug Des Devel Ther 2015; 9:5705-17. [PMID: 26543352 PMCID: PMC4622455 DOI: 10.2147/dddt.s92268] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cardiovascular disease is an important cause of morbidity and mortality among tobacco users. Varenicline is widely used worldwide to help smoking cessation, but some published studies have reported associated cardiovascular events. OBJECTIVE To determine the cardiovascular toxicity induced by varenicline in rats. MATERIALS AND METHODS We randomly separated 34 rats into two groups: 1) the control group (given only distilled water orally, n=10) and the varenicline group (given 9 μg/kg/day varenicline on days 1-3, 9 μg/kg twice daily on days 4-7, and 18 μg/kg twice daily on days 8-90 [total 83 days], n=24). Each group was then subdivided equally into acute and chronic subgroups, and all rats in these groups were euthanized with anesthesia overdose on days 45 and 90, respectively. Body and heart weights, hemodynamic (mean oxygen saturation, mean blood pressure, and heart rate, electrocardiographic (PR, QRS, and QT intervals) biochemical (oxidants and antioxidants), and histopathological analyses (including immunostaining) were performed. RESULTS Acute varenicline exposure resulted in loss of body weight, while chronic varenicline exposure caused heart weight loss and decreased mean blood pressure, induced lipid peroxidation, and reduced antioxidant activity. Both acute and chronic varenicline exposure caused impairment of mean oxygen saturation. QT interval was prolonged in the chronic varenicline group, while PR interval prolongation was statistically significant in both the control and acute varenicline groups. Caspase-9 activity was also significantly increased by chronic exposure. Moreover, histopathological observations revealed severe morphological heart damage in both groups. CONCLUSION Adverse effects of chronic varenicline exposure on cardiovascular tissue were confirmed by our electrocardiographic, biochemical, and histopathological analyses. This issue needs to be investigated with new experimental and clinical studies to evaluate the exact mechanism(s) of the detrimental effects of varenicline. Physicians should bear in mind the toxic effects of varenicline on the cardiovascular system when prescribing it for smoking cessation.
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Affiliation(s)
| | - Meltem Sungu
- Inonu University Medical Faculty, Malatya, Turkey
| | - Hakan Parlakpinar
- Department of Pharmacology, Inonu University Medical Faculty, Malatya, Turkey
| | - Necip Ermiş
- Department of Cardiology, Inonu University Medical Faculty, Malatya, Turkey
| | - Elif Taslıdere
- Department of Histology and Embryology, Inonu University Medical Faculty, Malatya, Turkey
| | - Nigar Vardı
- Department of Histology and Embryology, Inonu University Medical Faculty, Malatya, Turkey
| | - Murat Yalçınsoy
- Department of Pulmonary Medicine, Inonu University Medical Faculty, Malatya, Turkey
| | - Mustafa Sagır
- Department of Pharmacology, Inonu University Medical Faculty, Malatya, Turkey
| | - Alaaddin Polat
- Department of Physiology, Inonu University Medical Faculty, Malatya, Turkey
| | - Mehmet Karatas
- Department of Medical Ethics, Inonu University Medical Faculty, Malatya, Turkey
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Patnode CD, Henderson JT, Thompson JH, Senger CA, Fortmann SP, Whitlock EP. Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force. Ann Intern Med 2015; 163:608-21. [PMID: 26389650 DOI: 10.7326/m15-0171] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Tobacco use is the leading cause of preventable death in the United States. PURPOSE To review the effectiveness and safety of pharmacotherapy and behavioral interventions for tobacco cessation. DATA SOURCES 5 databases and 8 organizational Web sites were searched through 1 August 2014 for systematic reviews, and PubMed was searched through 1 March 2015 for trials on electronic nicotine delivery systems. STUDY SELECTION Two reviewers examined 114 articles to identify English-language reviews that reported health, cessation, or adverse outcomes. DATA EXTRACTION One reviewer abstracted data from good- and fair-quality reviews, and a second checked for accuracy. DATA SYNTHESIS 54 reviews were included. Behavioral interventions increased smoking cessation at 6 months or more (physician advice had a pooled risk ratio [RR] of 1.76 [95% CI, 1.58 to 1.96]). Nicotine replacement therapy (RR, 1.60 [CI, 1.53 to 1.68]), bupropion (RR, 1.62 [CI, 1.49 to 1.76]), and varenicline (RR, 2.27 [CI, 2.02 to 2.55]) were also effective for smoking cessation. Combined behavioral and pharmacotherapy interventions increased cessation by 82% compared with minimal intervention or usual care (RR, 1.82 [CI, 1.66 to 2.00]). None of the drugs were associated with major cardiovascular adverse events. Only 2 trials addressed efficacy of electronic cigarettes for smoking cessation and found no benefit. Among pregnant women, behavioral interventions benefited cessation and perinatal health; effects of nicotine replacement therapy were not significant. LIMITATION Evidence published after each review's last search date was not included. CONCLUSION Behavioral and pharmacotherapy interventions improve rates of smoking cessation among the general adult population, alone or in combination. Data on the effectiveness and safety of electronic nicotine delivery systems are limited. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Affiliation(s)
- Carrie D. Patnode
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jillian T. Henderson
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jamie H. Thompson
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Caitlyn A. Senger
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Stephen P. Fortmann
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Evelyn P. Whitlock
- From Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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A randomized controlled trial of the efficacy and safety of varenicline for smoking cessation after acute coronary syndrome: design and methods of the Evaluation of Varenicline in Smoking Cessation for Patients Post-Acute Coronary Syndrome trial. Am Heart J 2015; 170:635-640.e1. [PMID: 26386786 DOI: 10.1016/j.ahj.2015.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/11/2015] [Indexed: 11/20/2022]
Abstract
UNLABELLED Patients who continue to smoke after an acute coronary syndrome (ACS) have a significantly increased risk of reinfarction and death compared with those who quit. Varenicline is a first-line smoking cessation therapy with proven efficacy in the general population. However, its efficacy and safety immediately after an ACS are unknown. METHODS The EVITA trial is a multicenter, double-blind, randomized, placebo-controlled trial (NCT00794573). The primary objective is to evaluate the efficacy of varenicline after ACS in achieving biochemically validated smoking abstinence at 24 weeks. The secondary objectives are to examine the efficacy of varenicline for smoking abstinence and reduction in daily cigarette consumption at 52 weeks and to describe the occurrence of adverse events. Three hundred and two patients motivated to quit smoking were enrolled in the United States and Canada from November 2009 to December 2014 while hospitalized with an ACS. These participants were randomized (1:1) to either varenicline (1.0 mg twice daily) or placebo for 12 weeks. The trial includes follow-ups by telephone at weeks 1, 2, and 8 and clinic visits at weeks 4, 12, 24, and 52. Data collected include demographic and clinical characteristics, self-reported smoking, exhaled carbon monoxide (an indicator of current smoking), and adverse events. CONCLUSION The EVITA trial will provide novel information concerning the efficacy and safety of varenicline immediately after ACS. If varenicline is efficacious in this population, it will have a major impact on secondary prevention of recurrent clinical events in patients post-ACS.
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Kotz D, Viechtbauer W, Simpson C, van Schayck OCP, West R, Sheikh A. Cardiovascular and neuropsychiatric risks of varenicline: a retrospective cohort study. THE LANCET RESPIRATORY MEDICINE 2015; 3:761-8. [PMID: 26355008 PMCID: PMC4593936 DOI: 10.1016/s2213-2600(15)00320-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 12/29/2022]
Abstract
Background Varenicline is an effective pharmacotherapy to aid smoking cessation. However, its use is limited by continuing concerns about possible associated risks of serious adverse cardiovascular and neuropsychiatric events. The aim of this study was to investigate whether use of varenicline is associated with such events. Methods In this retrospective cohort study, we used data from patients included in the validated QResearch database, which holds data from 753 National Health Service general practices across England. We identified patients aged 18–100 years (registered for longer than 12 months before data extraction) who received a prescription of nicotine replacement treatment (NRT; reference group), bupropion, or varenicline. We excluded patients if they had used one of the drugs during the 12 months before the start date of the study, had received a prescription of a combination of these drugs during the follow-up period, or were temporary residents. We followed patients up for 6 months to compare incident cardiovascular (ischaemic heart disease, cerebral infarction, heart failure, peripheral vascular disease, and cardiac arrhythmia) and neuropsychiatric (depression and self-harm) events using Cox proportional hazards models, adjusted for potential confounders (primary outcomes). Findings We identified 164 766 patients who received a prescription (106 759 for nicotine replacement treatment; 6557 for bupropion; 51 450 for varenicline) between Jan 1, 2007, and June 30, 2012. Neither bupropion nor varenicline showed an increased risk of any cardiovascular or neuropsychiatric event compared with NRT (all hazard ratios [HRs] less than 1. Varenicline was associated with a significantly reduced risk of ischaemic heart disease (HR 0·80 [95%CI 0·72–0·87]), cerebral infarction (0·62 [0·52–0·73]), heart failure (0·61 [0·45–0·83]), arrhythmia (0·73 [0·60–0·88]), depression (0·66 [0·63–0·69]), and self-harm (0·56 [0·46–0·68]). Interpretation Varenicline does not seem to be associated with an increased risk of documented cardiovascular events, depression, or self-harm when compared with NRT. Adverse events that do not come to attention of general practitioners cannot be excluded. These findings suggest an opportunity for physicians to prescribe varenicline more broadly, even for patients with comorbidities, thereby helping more smokers to quit successfully than do at present. Funding Egton Medical Information Systems, University of Nottingham, Ministry of Innovation, Science and Research of the German Federal State of North Rhine-Westphalia, Cancer Research UK, Medical Research Council, Commonwealth Fund.
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Affiliation(s)
- Daniel Kotz
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, Netherlands; Allergy and Respiratory Research Group, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; Cancer Research UK Health Behaviour Research Centre, University College London, London, UK.
| | - Wolfgang Viechtbauer
- MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Colin Simpson
- Allergy and Respiratory Research Group, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Onno C P van Schayck
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, Netherlands; Allergy and Respiratory Research Group, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Aziz Sheikh
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, Netherlands; Allergy and Respiratory Research Group, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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70
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Pharmacological therapies in smoking cessation: an evidence-based update. CURRENT PULMONOLOGY REPORTS 2015. [DOI: 10.1007/s13665-015-0125-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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West R, Raw M, McNeill A, Stead L, Aveyard P, Bitton J, Stapleton J, McRobbie H, Pokhrel S, Lester‐George A, Borland R. Health-care interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development. Addiction 2015; 110:1388-403. [PMID: 26031929 PMCID: PMC4737108 DOI: 10.1111/add.12998] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 03/10/2015] [Accepted: 05/22/2015] [Indexed: 12/11/2022]
Abstract
AIMS This paper provides a concise review of the efficacy, effectiveness and affordability of health-care interventions to promote and assist tobacco cessation, in order to inform national guideline development and assist countries in planning their provision of tobacco cessation support. METHODS Cochrane reviews of randomized controlled trials (RCTs) of major health-care tobacco cessation interventions were used to derive efficacy estimates in terms of percentage-point increases relative to comparison conditions in 6-12-month continuous abstinence rates. This was combined with analysis and evidence from 'real world' studies to form a judgement on the probable effectiveness of each intervention in different settings. The affordability of each intervention was assessed for exemplar countries in each World Bank income category (low, lower middle, upper middle, high). Based on World Health Organization (WHO) criteria, an intervention was judged as affordable for a given income category if the estimated extra cost of saving a life-year was less than or equal to the per-capita gross domestic product for that category of country. RESULTS Brief advice from a health-care worker given opportunistically to smokers attending health-care services can promote smoking cessation, and is affordable for countries in all World Bank income categories (i.e. globally). Proactive telephone support, automated text messaging programmes and printed self-help materials can assist smokers wanting help with a quit attempt and are affordable globally. Multi-session, face-to-face behavioural support can increase quit success for cigarettes and smokeless tobacco and is affordable in middle- and high-income countries. Nicotine replacement therapy, bupropion, nortriptyline, varenicline and cytisine can all aid quitting smoking when given with at least some behavioural support; of these, cytisine and nortriptyline are affordable globally. CONCLUSIONS Brief advice from a health-care worker, telephone helplines, automated text messaging, printed self-help materials, cytisine and nortriptyline are globally affordable health-care interventions to promote and assist smoking cessation. Evidence on smokeless tobacco cessation suggests that face-to-face behavioural support and varenicline can promote cessation.
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Affiliation(s)
- Robert West
- Cancer Research UK Health Behaviour Research CentreUniversity College LondonLondonUK
| | - Martin Raw
- Special Lecturer, UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public HealthUniversity of NottinghamNottinghamUK
| | - Ann McNeill
- Professor of Tobacco Addiction, King's College London, UK Centre for Tobacco and Alcohol StudiesNational Addiction CentreLondonUK
| | - Lindsay Stead
- Cochrane Tobacco Addiction Group, Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Paul Aveyard
- Professor of Behavioural Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory QuarterUniversity of OxfordOxfordUK
| | - John Bitton
- Professor of Epidemiology, UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology and Public HealthUniversity of NottinghamNottinghamUK
| | - John Stapleton
- Reader in Addiction Statistical Analysis, Addictions Department, Institute of PsychiatryKings College LondonLondonUK
| | - Hayden McRobbie
- Reader in Public Health Interventions, Wolfson Institute of Preventive MedicineQueen Mary University of LondonLondonUK
| | - Subhash Pokhrel
- Health Economics Research GroupBrunel University LondonUxbridgeUK
| | | | - Ron Borland
- Cancer Council Victoria, Melbourne, VictoriaAustralia
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Abstract
The tobacco addiction treatment field is progressing through innovations in medication development, a focus on precision medicine, and application of new technologies for delivering support in real time and over time. This article reviews the evidence for combined and extended cessation pharmacotherapy and behavioral strategies including provider advice, individual counseling, group programs, the national quitline, websites and social media, and incentives. Healthcare policies are changing to offer cessation treatment to the broad population of smokers. With knowledge of the past and present, this review anticipates what is likely on the horizon in the clinical and public health effort to address tobacco addiction.
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Affiliation(s)
- Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California 94305;
| | - Neal L Benowitz
- Departments of Medicine and Bioengineering & Therapeutic Sciences, Division of Clinical Pharmacology and Experimental Therapeutics, University of California, San Francisco, California 94143;
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73
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Denaxas SC, Morley KI. Big biomedical data and cardiovascular disease research: opportunities and challenges. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2015; 1:9-16. [PMID: 29474568 DOI: 10.1093/ehjqcco/qcv005] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/21/2015] [Indexed: 12/13/2022]
Abstract
Electronic health records (EHRs), data generated and collected during normal clinical care, are increasingly being linked and used for translational cardiovascular disease research. Electronic health record data can be structured (e.g. coded diagnoses) or unstructured (e.g. clinical notes) and increasingly encapsulate medical imaging, genomic and patient-generated information. Large-scale EHR linkages enable researchers to conduct high-resolution observational and interventional clinical research at an unprecedented scale. A significant amount of preparatory work and research, however, is required to identify, obtain, and transform raw EHR data into research-ready variables that can be statistically analysed. This study critically reviews the opportunities and challenges that EHR data present in the field of cardiovascular disease clinical research and provides a series of recommendations for advancing and facilitating EHR research.
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Affiliation(s)
- Spiros C Denaxas
- Farr Institute of Health Informatics Research, University College London, 222 Euston Road, London NW1 2DA, UK.,Institute of Health Informatics, University College London, UK
| | - Katherine I Morley
- Farr Institute of Health Informatics Research, University College London, 222 Euston Road, London NW1 2DA, UK.,National Addiction Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
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74
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Abstract
Smoking is a modifiable risk factor for morbidity and mortality caused by cancer, cardiovascular diseases, respiratory diseases, and many other diseases. Given the large population size and high prevalence of smoking in Asia, successful smoking cessation could potentially prevent the large number of premature deaths in Asians. However, most dependent smokers cannot successfully quit smoking due to nicotine addiction, and they need professional help and smoking cessation therapies. Varenicline is a highly selective partial agonist for the nicotinic acetylcholine receptor α4β2 subtype, which is believed to be responsible for mediating the reinforcing properties of nicotine. This article is a narrative review, which summarizes the smoking cessation efficacy, side effects, and cost utilities of varenicline in Asians. From this review, we conclude that varenicline is an effective medication that could assist smoking cessation in the Asian populations. The adverse events of varenicline are tolerable, and the most common events were nausea and abnormal dreams. Both the efficacy and tolerance of varenicline in Asians are similar to that in Western populations. Considering the cost utilities, varenicline should be recommended for use in smoking cessation and be covered by medical insurance in most Asian countries.
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Affiliation(s)
- Dan Xiao
- Clinical Cessation and Tobacco Medicine Research Centre, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Shuilian Chu
- Clinical Cessation and Tobacco Medicine Research Centre, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Chen Wang
- Clinical Cessation and Tobacco Medicine Research Centre, China-Japan Friendship Hospital, Beijing, People’s Republic of China
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75
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Wippold R, Karam-Hage M, Blalock J, Cinciripini P. Selection of optimal tobacco cessation medication treatment in patients with cancer. Clin J Oncol Nurs 2015; 19:170-5. [PMID: 25840382 DOI: 10.1188/15.cjon.170-175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tobacco use is responsible for almost half a million deaths per year in the United States, and it accounts for one-third of all cancer deaths. Limited data concerning tobacco treatment among patients with cancer are available. In addition, these patients often have complicated medical histories and are taking multiple medications. No clear, published procedures exist to help the healthcare provider select the proper medication for tobacco cessation in that context. OBJECTIVES This article describes the screening process established within the Tobacco Treatment Program (TTP) at the University of Texas MD Anderson Cancer Center to minimize the risk of prescribing a contraindicated tobacco cessation medication to patients with cancer. The screening process developed and used by the TTP is presented as a viable model for selecting appropriate tobacco cessation medications for patients with cancer. METHODS The electronic medical record of each patient who uses tobacco is carefully reviewed once he or she is scheduled for a consultation. A summary is produced with a standardized template and used later as a template for the medical provider evaluation. Precautions are put in place with consideration of the characteristics of each of the tobacco cessation medications (e.g., mechanism of action, route of administration, interactions with other medications, possible side effects, contraindications). Since 2006, the TTP has had more than 4,000 new patients and more than 39,000 follow-up visits. FINDINGS Because each patient with cancer has unique medical, psychological, and social circumstances, the process of selecting the optimal tobacco cessation medication needs to be individualized. Oncology healthcare providers should follow some form of screening to tailor a medication plan to each patient.
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Affiliation(s)
- Rosario Wippold
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center in Houston
| | - Maher Karam-Hage
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center in Houston
| | - Janice Blalock
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center in Houston
| | - Paul Cinciripini
- Tobacco Treatment Program and Department of Behavioral Science, University of Texas MD Anderson Cancer Center in Houston
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76
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Sager PT, Seltzer J, Turner JR, Anderson JL, Hiatt WR, Kowey P, Prochaska JJ, Stockbridge N, White WB. Cardiovascular Safety Outcome Trials: A meeting report from the Cardiac Safety Research Consortium. Am Heart J 2015; 169:486-95. [PMID: 25819855 DOI: 10.1016/j.ahj.2015.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 01/21/2023]
Abstract
This White Paper provides a summary of presentations and discussions at a Cardiovascular Safety Outcome Trials Think Tank cosponsored by the Cardiac Safety Research Consortium, the US Food and Drug Administration, and the American College of Cardiology, held at American College of Cardiology's Heart House, Washington, DC, on February 19, 2014. Studies to assess cardiovascular (CV) risk of a new drug are sometimes requested by regulators to resolve ambiguous safety signals seen during its development or among other members of its class. Think Tank participants thought that important considerations in undertaking such studies were as follows: (1) plausibility-how likely it is that a possible signal indicating risk is real, based on strength of evidence, and/or whether a plausible mechanism of action for potential CV harm has been identified; (2) relevance-what relative and absolute CV risk would need to be excluded to determine that the drug had an acceptable benefit-to-risk balance for its use in the intended patient population; and (3) how plausibility and relevance influence the timing and approach to further safety assessment.
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Affiliation(s)
| | | | | | | | - William R Hiatt
- Division of Cardiology/CPC Clinical Research, University of Colorado School of Medicine, Aurora, CO
| | | | | | | | - William B White
- Cardiology Center, University of Connecticut School of Medicine, Farmington, CT.
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77
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Thomas KH, Martin RM, Knipe DW, Higgins JPT, Gunnell D. Risk of neuropsychiatric adverse events associated with varenicline: systematic review and meta-analysis. BMJ 2015; 350:h1109. [PMID: 25767129 PMCID: PMC4357491 DOI: 10.1136/bmj.h1109] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the risk of neuropsychiatric adverse events associated with use of varenicline compared with placebo in randomised controlled trials. DESIGN Systematic review and meta-analysis comparing study effects using two summary estimates in fixed effects models, risk differences, and Peto odds ratios. DATA SOURCES Medline, Embase, PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials with a placebo comparison group that reported on neuropsychiatric adverse events (depression, suicidal ideation, suicide attempt, suicide, insomnia, sleep disorders, abnormal dreams, somnolence, fatigue, anxiety) and death. Studies that did not involve human participants, did not use the maximum recommended dose of varenicline (1 mg twice daily), and were cross over trials were excluded. RESULTS In the 39 randomised controlled trials (10,761 participants), there was no evidence of an increased risk of suicide or attempted suicide (odds ratio 1.67, 95% confidence interval 0.33 to 8.57), suicidal ideation (0.58, 0.28 to 1.20), depression (0.96, 0.75 to 1.22), irritability (0.98, 0.81 to 1.17), aggression (0.91, 0.52 to 1.59), or death (1.05, 0.47 to 2.38) in the varenicline users compared with placebo users. Varenicline was associated with an increased risk of sleep disorders (1.63, 1.29 to 2.07), insomnia (1.56, 1.36 to 1.78), abnormal dreams (2.38, 2.05 to 2.77), and fatigue (1.28, 1.06 to 1.55) but a reduced risk of anxiety (0.75, 0.61 to 0.93). Similar findings were observed when risk differences were reported. There was no evidence for a variation in depression and suicidal ideation by age group, sex, ethnicity, smoking status, presence or absence of psychiatric illness, and type of study sponsor (that is, pharmaceutical industry or other). CONCLUSIONS This meta-analysis found no evidence of an increased risk of suicide or attempted suicide, suicidal ideation, depression, or death with varenicline. These findings provide some reassurance for users and prescribers regarding the neuropsychiatric safety of varenicline. There was evidence that varenicline was associated with a higher risk of sleep problems such as insomnia and abnormal dreams. These side effects, however, are already well recognised. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2014:CRD42014009224.
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Affiliation(s)
- Kyla H Thomas
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Duleeka W Knipe
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Julian P T Higgins
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
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78
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Sivadasan Pillai H, Ganapathi S. Tobacco Cessation Approaches and Impact on CVD. Glob Heart 2015; 7:129-38. [PMID: 25691309 DOI: 10.1016/j.gheart.2012.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 06/06/2012] [Indexed: 12/30/2022] Open
Affiliation(s)
- Harikrishnan Sivadasan Pillai
- Department of Cardiology, Sree ChitraTirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India; Correspondence: S. Harikrishnan
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Munarini E, Marabelli C, Pozzi P, Boffi R. Extended varenicline treatment in a severe cardiopathic cigarette smoker: a case report. J Med Case Rep 2015; 9:29. [PMID: 25971250 PMCID: PMC4429485 DOI: 10.1186/1752-1947-9-29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/16/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Tobacco smoking is the leading cause of cardiovascular morbidity and mortality and quitting tobacco use should be fundamental for cardiovascular patients. Varenicline is a smoking cessation pharmacological therapy able to improve the possibilities to successfully achieve this result. In 2011 the US Food and Drug Administration issued a safety announcement that varenicline may be associated with an increased risk of certain cardiovascular adverse events in patients who have cardiovascular disease. Following studies found no significant increase in cardiovascular serious adverse events associated with varenicline. For the first time in the literature, we describe the case of a cardiopathic hard smoker who received varenicline for 9 months without any side effect. By describing this case we want to underline the safety of varenicline, to illustrate the setting and the method that we used to support him and to underline the importance of promoting smoking cessation in heart patients. CASE PRESENTATION Varenicline was used to promote smoking cessation in a 52-year-old Caucasian man who smoked 40 cigarettes per day, despite two ischemic cardiovascular events. He asked for a consultation in a pharmacy's smoking cessation service and after the assessment phase varenicline was prescribed. Due to his difficulty to quit smoking and given his good tolerance of the drug, we extended the treatment with varenicline to 9 months in order to achieve and maintain a complete smoking abstinence; intensive behavioural counselling was combined with the pharmacological therapy. By using exhaled carbon monoxide measurement we assessed smoking abstinence up to 2 years. CONCLUSIONS The use of varenicline for a period longer than 6 months has not been described in the literature, particularly in heart patients. The extended varenicline therapy was clinically monitored and allowed the patient to consolidate his abstinence; the intensive behavioural counselling helped him to overcome his strong psychological dependence. Promoting smoking cessation in people who have cardiovascular disease is crucial. Currently available medications, such as varenicline, increase the chances of success and the risk of possible side effects is outweighed by the lifetime benefits and we hope that clinicians use them more frequently and confidently.
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Affiliation(s)
- Elena Munarini
- Tobacco Control Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy.
| | - Chiara Marabelli
- Tobacco Control Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy.
| | - Paolo Pozzi
- Tobacco Control Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy.
| | - Roberto Boffi
- Tobacco Control Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy.
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Polepalli Ramesh B, Sethi RJ, Yu H. Figure-associated text summarization and evaluation. PLoS One 2015; 10:e0115671. [PMID: 25643357 PMCID: PMC4313946 DOI: 10.1371/journal.pone.0115671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 11/26/2014] [Indexed: 11/18/2022] Open
Abstract
Biomedical literature incorporates millions of figures, which are a rich and important knowledge resource for biomedical researchers. Scientists need access to the figures and the knowledge they represent in order to validate research findings and to generate new hypotheses. By themselves, these figures are nearly always incomprehensible to both humans and machines and their associated texts are therefore essential for full comprehension. The associated text of a figure, however, is scattered throughout its full-text article and contains redundant information content. In this paper, we report the continued development and evaluation of several figure summarization systems, the FigSum+ systems, that automatically identify associated texts, remove redundant information, and generate a text summary for every figure in an article. Using a set of 94 annotated figures selected from 19 different journals, we conducted an intrinsic evaluation of FigSum+. We evaluate the performance by precision, recall, F1, and ROUGE scores. The best FigSum+ system is based on an unsupervised method, achieving F1 score of 0.66 and ROUGE-1 score of 0.97. The annotated data is available at figshare.com (http://figshare.com/articles/Figure_Associated_Text_Summarization_and_Evaluation/858903).
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Affiliation(s)
- Balaji Polepalli Ramesh
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Ricky J. Sethi
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Hong Yu
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States of America
- School of Computer Science, University of Massachusetts, Amherst, MA, United States of America
- VA Central Western Massachusetts, Leeds, MA, United States of America
- * E-mail:
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81
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Kasza KA, Cummings KM, Carpenter MJ, Cornelius ME, Hyland AJ, Fong GT. Use of stop-smoking medications in the United States before and after the introduction of varenicline. Addiction 2015; 110:346-55. [PMID: 25331778 PMCID: PMC4469178 DOI: 10.1111/add.12778] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/18/2014] [Accepted: 10/14/2014] [Indexed: 11/29/2022]
Abstract
AIMS To evaluate trends in use of stop-smoking medications (SSMs) before and after varenicline (Chantix™) was introduced to the market-place in the United States, and to determine whether varenicline reached segments of the population unlikely to use other SSMs. DESIGN Cohort survey. SETTING United States. PARTICIPANTS A nationally representative sample of adult smokers in the United States interviewed as part of the International Tobacco Control Four Country Survey between 2004 and 2011. Primary analyses used cross-sectional data from 1737 smokers who attempted to quit (∼450 per wave). MEASUREMENTS Reporting an attempt to quit smoking; use of each of the following types of SSMs for the purpose of quitting smoking: nicotine gum, nicotine patch, other nicotine replacement therapy, bupropion and varenicline. FINDINGS There was a significant increase in the rate of use of any SSM among quit attempters across the study period [odds ratio (OR) = 1.15, 95% confidence interval (CI) = 1.10-1.21 per year]. This increase was largest after varenicline was introduced (OR = 1.16, 95% CI = 1.07-1.26 per year); however, there was a decline in nicotine patch use during this time (OR = 0.87, 95% CI = 0.76-0.99 per year). Varenicline users were generally similar to users of other SSMs but differed from those who did not use any SSMs, in that they tended to be older (OR = 5.46, P = 0.024), to be white (OR = 2.33, P = 0.002), to have high incomes (OR = 1.85, P = 0.005), to have high nicotine dependence prior to quitting (OR = 2.40, P = 0.001) and to have used medication in the past (OR = 3.29, P < 0.001). CONCLUSIONS The introduction of varenicline in the United States coincided with a net increase in attempts to quit smoking and, among these, a net increase in use of stop-smoking medications. The demographic profile of varenicline users is similar to the profile of those who use other stop-smoking medications and different from the profile of those who attempt to quit without any medication.
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Affiliation(s)
- Karin A Kasza
- Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA
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82
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Tanaka S, Tanaka S, Kawakami K. Methodological issues in observational studies and non-randomized controlled trials in oncology in the era of big data. Jpn J Clin Oncol 2015; 45:323-7. [PMID: 25589456 DOI: 10.1093/jjco/hyu220] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Non-randomized controlled trials, cohort studies and database studies are appealing study designs when there are urgent needs for safety data, outcomes of interest are rare, generalizability is a matter of concern, or randomization is not feasible. This paper reviews four typical case studies from methodological viewpoints and clarifies how to minimize bias in observational studies in oncology. In summary, researchers planning observational studies should be cautious of selection of appropriate databases, validity of algorithms for identifying outcomes, comparison with incident users or self-control, rigorous collection of information on potential confounders and reporting details of subject selection. Further, a careful study protocol and statistical analysis plan are also necessary.
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Affiliation(s)
- Shiro Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Sachiko Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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83
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Koga M, Kanaoka Y, Ohkido Y, Kubo N, Ohishi K, Sugiyama K, Yamauchi A, Kataoka Y. Varenicline aggravates plaque formation through α7 nicotinic acetylcholine receptors in ApoE KO mice. Biochem Biophys Res Commun 2014; 455:194-7. [DOI: 10.1016/j.bbrc.2014.10.150] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 10/29/2014] [Indexed: 11/29/2022]
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84
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Sharma A, Thakar S, Lavie CJ, Garg J, Krishnamoorthy P, Sochor O, Arbab-Zadeh A, Lichstein E. Cardiovascular adverse events associated with smoking-cessation pharmacotherapies. Curr Cardiol Rep 2014; 17:554. [PMID: 25410148 DOI: 10.1007/s11886-014-0554-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Smoking continues to be the leading cause of preventable deaths in the USA, accounting for one in every five deaths every year, and cardiovascular (CV) disease remains the leading cause of those deaths. Hence, there is increasing awareness to quit smoking among the public and counseling plays an important role in smoking cessation. There are different pharmacological methods to help quit smoking that includes nicotine replacement products available over the counter, including patch, gum, and lozenges, to prescription medications, such as bupropion and varenicline. There have been reports of both nonserious and serious adverse CV events associated with the use of these different pharmacological methods, especially varenicline, which has been gaining media attention recently. Therefore, we systematically reviewed the various pharmacotherapies used in smoking cessation and analyzed the evidence behind these CV events reported with these therapeutic agents.
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Affiliation(s)
- Abhishek Sharma
- Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA,
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85
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Balmford J, Leifert JA, Jaehne A. "Tobacco dependence treatment makes no sense because"…: rebuttal of commonly-heard arguments against providing tobacco dependence treatment in the hospital setting. BMC Public Health 2014; 14:1182. [PMID: 25410166 PMCID: PMC4289053 DOI: 10.1186/1471-2458-14-1182] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 09/15/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The provision of tobacco dependence treatment in health care settings, particularly in countries lacking a history of strong tobacco control policy implementation, is limited by continued misconceptions on the part of health professionals and decision-makers regarding its worth and efficacy. In this paper, we rebut 9 arguments against the provision of tobacco dependence treatment that we have encountered in our experiences implementing and maintaining a dedicated smoking cessation service at a large university hospital in southern Germany. DISCUSSION Broadly, the arguments relate to the nature of addiction, the efficacy and safety of stop-smoking medication and behavioural support, and the benefits and challenges of quitting. They include: (a) If smokers really want to quit, they will be able to do it alone (without help); (b) You can't forbid patients from doing what they want; (c) Patients will be upset if you talk to them about their smoking; (d) Stop-smoking medication has side effects that are more dangerous than smoking; (e) You have to be well trained to help smokers to quit (otherwise you can do more harm than good); (f) If you smoke yourself, you lack credibility; (g) If you have cancer, it is too late to quit; (h) Nicotine withdrawal is dangerous for heavy smokers; and (i) Smokers die earlier, thus reducing costs to the health system. SUMMARY It is hoped that the counter-arguments presented here arm tobacco control advocates and practitioners working in health care settings, particularly in countries which have not prioritised tobacco control, to respond appropriately and convincingly to those opposed to the provision of tobacco dependence treatment.
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Affiliation(s)
- James Balmford
- />Präventionsteam (PT), Tumorzentrum Freiburg, Albert-Ludwigs-Universität Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Jens A Leifert
- />Department of Internal Medicine, Breisgauklinik, Bad Krozingen, Germany
| | - Andreas Jaehne
- />Präventionsteam (PT), Tumorzentrum Freiburg, Albert-Ludwigs-Universität Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
- />Department of Psychiatry & Psychotherapy, Universitätsklinikum Freiburg, Freiburg, Germany
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86
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Barry AR, Koshman SL, Pearson GJ. Adverse drug reactions: The importance of maintaining pharmacovigilance. Can Pharm J (Ott) 2014; 147:233-8. [PMID: 25360149 DOI: 10.1177/1715163514536523] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Arden R Barry
- Mazankowski Alberta Heart Institute (Barry, Koshman, Pearson), Alberta Health Services, Edmonton
| | - Sheri L Koshman
- Mazankowski Alberta Heart Institute (Barry, Koshman, Pearson), Alberta Health Services, Edmonton
| | - Glen J Pearson
- Mazankowski Alberta Heart Institute (Barry, Koshman, Pearson), Alberta Health Services, Edmonton
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87
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Kotz D, Simpson C, Viechtbauer W, van Schayck OCP, West R, Sheikh A. Cardiovascular and neuropsychiatric safety of varenicline and bupropion compared with nicotine replacement therapy for smoking cessation: study protocol of a retrospective cohort study using the QResearch general practice database. BMJ Open 2014; 4:e005281. [PMID: 25168037 PMCID: PMC4156814 DOI: 10.1136/bmjopen-2014-005281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/15/2014] [Accepted: 07/17/2014] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Cigarette smoking continues to be the leading cause of preventable death and is the main risk factor of major diseases such as chronic obstructive pulmonary disease (COPD). The best treatment to help smokers quit is a combination of behavioural support with pharmacotherapy. Varenicline is the newest drug on the market and has been shown to be effective in the general smoking population and in smokers with COPD. The safety profile of varenicline was initially established using standard approaches to pharmacovigilance, but postmarketing reports have raised concerns about a possible association between the use of varenicline and cardiovascular and neuropsychiatric events. Although recent studies have not confirmed such an association, further research is needed given the large number of smokers who are being prescribed varenicline, including important subgroups such as smokers with COPD who may be particularly vulnerable to side effects of drugs. The aim of this study is to assess the cardiovascular and neuropsychiatric safety of varenicline using data from the QResearch general practice (GP) database. METHODS AND ANALYSIS We will conduct a retrospective cohort study in the QResearch GP database. Patients will be categorised into three exposure groups: prescription of (1) varenicline, (2) bupropion or (3) nicotine replacement therapy (NRT Rx; =reference group). We will separately consider major incident neuropsychiatric and cardiovascular outcomes that occur during 6 months of follow-up using Cox proportional hazards models, adjusted for confounders. Furthermore, propensity score analysis will be used as an analytical approach to account for potential confounding by indication. ETHICS AND DISSEMINATION This work involves analysis of anonymised, routinely collected data. The protocol has been independently peer-reviewed by the QResearch Scientific Board and meets the requirements of the Trent research ethics committee. We plan to disseminate the results from this study via articles in international peer-reviewed journals and presentations at relevant national and international health conferences.
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Affiliation(s)
- Daniel Kotz
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Colin Simpson
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Wolfgang Viechtbauer
- MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Aziz Sheikh
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
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88
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Chelladurai Y, Singh S. Varenicline and cardiovascular adverse events: a perspective review. Ther Adv Drug Saf 2014; 5:167-72. [PMID: 25083271 DOI: 10.1177/2042098614530421] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Smoking is a leading preventable cause of mortality and morbidity. Varenicline, a first-line smoking cessation aid, is used widely to achieve successful quit rates in smokers. A number of studies and systematic reviews have evaluated the safety profile of the drug. To date, three systematic reviews by Singh and colleagues, Prochaska and Hilton, and Ware and colleagues, published between 2011 and 2013, have evaluated serious cardiovascular adverse events with varenicline use. Even though all three reviews demonstrated that serious cardiovascular adverse events were nominally more frequent in varenicline-treated patients when compared with placebo, a significantly increased event rate was found only in the review by Singh and colleagues. The three reviews included similar trials but differed in the evaluation of outcomes and performance of summary statistic computation. Though the evidence from the two most recent systematic reviews demonstrated that risk of serious cardiovascular events might not be increased with varenicline use, the US Food and Drug Administration has advised prescription with caution combined with close monitoring and education of patients until more conclusive evidence is available. Results of these reviews cannot be generalized to patients with unstable cardiac conditions.
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Affiliation(s)
| | - Sonal Singh
- Department of Medicine, Johns Hopkins University, E7144, 624 N Wolfe St, Baltimore, MD 21205, USA
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89
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Carson KV, Smith BJ, Brinn MP, Peters MJ, Fitridge R, Koblar SA, Jannes J, Singh K, Veale AJ, Goldsworthy S, Litt J, Edwards D, Hnin KM, Esterman AJ. Safety of varenicline tartrate and counseling versus counseling alone for smoking cessation: a randomized controlled trial for inpatients (STOP study). Nicotine Tob Res 2014; 16:1495-502. [PMID: 25031315 DOI: 10.1093/ntr/ntu112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Inpatient medical settings offer an opportunistic environment for initiating smoking cessation interventions to patients reflecting on their health. Current evidence has shown the superior efficacy of varenicline tartrate (VT) for smoking cessation compared with other tobacco cessation therapies; however, recent evidence also has highlighted concerns about the safety and tolerability of VT. Given these apprehensions, we aimed to evaluate the safety and effectiveness of VT plus quitline-counseling compared to quitline-counseling alone in the inpatient medical setting. METHODS Adult patients (n = 392, 20-75 years) admitted with a smoking-related illnesses to 3 hospitals were randomized to receive either 12 weeks of varenicline tartrate (titrated from 0.5mg daily to 1mg twice daily) plus quitline-counseling (VT+C), (n = 196) or quitline-counseling alone (n = 196). RESULTS VT was well tolerated in the inpatient setting among subjects admitted with acute smoking-related illnesses (mean age 52.8±2.89 and 53.7±2.77 years in the VT+C and counseling alone groups, respectively). The most common self-reported adverse event during the 12-week treatment phase was nausea (16.3% in the VT+C group compared with 1.5% in the counseling alone group). Thirteen deaths occurred during the study period (n = 6 were in the VT+C arm compared with n = 7 in the counseling alone arm). All of these subjects had known comorbidities or developed underlying comorbidities. CONCLUSIONS VT appears to be a safe and well-tolerated opportunistic treatment for inpatient smokers who have related chronic disease. Based on the proven efficacy of varenicline from outpatient studies and our recent inpatient evidence, we suggest it be considered as part of standard care in the hospital setting.
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Affiliation(s)
- Kristin Veronica Carson
- Clinical Practice Unit, Basil Hetzel Research Institute, Adelaide, South Australia, Australia; Respiratory Medicine, Queen Elizabeth Hospital, Adelaide, South Australia, Australia;
| | - Brian James Smith
- Clinical Practice Unit, Basil Hetzel Research Institute, Adelaide, South Australia, Australia; Respiratory Medicine, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Malcolm Philip Brinn
- Clinical Practice Unit, Basil Hetzel Research Institute, Adelaide, South Australia, Australia; Respiratory Medicine, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Matthew J Peters
- Thoracic Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Robert Fitridge
- Division of Surgery, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Simon A Koblar
- Stroke Research Programme, University of Adelaide, Adelaide, South Australia, Australia
| | - Jim Jannes
- Stroke Research Programme, University of Adelaide, Adelaide, South Australia, Australia; Stroke Unit, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Kuljit Singh
- Cardiolgoy Department, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Antony J Veale
- Clinical Practice Unit, Basil Hetzel Research Institute, Adelaide, South Australia, Australia; Respiratory Medicine, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Sharon Goldsworthy
- Pharmacy, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - John Litt
- Discipline of General Practice, Flinders University, Adelaide, South Australia, Australia
| | - David Edwards
- Cancer Council of South Australia, Adelaide, South Australia, Australia
| | - Khin Moe Hnin
- Respiratory Medicine, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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90
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Graham DJ, By K, McKean S, Mosholder A, Kornegay C, Racoosin JA, Young J, Levenson M, MaCurdy TE, Worrall C, Kelman JA. Cardiovascular and mortality risks in older Medicare patients treated with varenicline or bupropion for smoking cessation: an observational cohort study. Pharmacoepidemiol Drug Saf 2014; 23:1205-12. [DOI: 10.1002/pds.3678] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/09/2014] [Accepted: 06/09/2014] [Indexed: 11/06/2022]
Affiliation(s)
- David J. Graham
- Office of Surveillance and Epidemiology; Food and Drug Administration; Silver Spring MD USA
| | - Kunthel By
- Office of Biostatistics; Food and Drug Administration; Silver Spring MD USA
| | | | - Andrew Mosholder
- Office of Surveillance and Epidemiology; Food and Drug Administration; Silver Spring MD USA
| | - Cynthia Kornegay
- Office of Surveillance and Epidemiology; Food and Drug Administration; Silver Spring MD USA
| | | | | | - Mark Levenson
- Office of Biostatistics; Food and Drug Administration; Silver Spring MD USA
| | | | - Chris Worrall
- Centers for Medicare & Medicaid Services; Washington, DC USA
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91
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Tulloch H, Pipe A, Els C, Aitken D, Clyde M, Corran B, Reid RD. Flexible and extended dosing of nicotine replacement therapy or varenicline in comparison to fixed dose nicotine replacement therapy for smoking cessation: rationale, methods and participant characteristics of the FLEX trial. Contemp Clin Trials 2014; 38:304-13. [PMID: 24861558 DOI: 10.1016/j.cct.2014.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/13/2014] [Accepted: 05/16/2014] [Indexed: 01/23/2023]
Abstract
Quitting smoking is the single most effective strategy to reduce morbidity and premature mortality in smokers. Research has demonstrated the effectiveness of pharmacotherapy in smoking cessation, but few studies have directly compared varenicline and monotherapy nicotine replacement therapy (NRT) and none have examined varenicline and combinations of NRT products. The majority of smoking cessation trials involve carefully circumscribed populations, making their results less generalizable to those with severe medical conditions or psychiatric comorbidities. This paper reports on the rationale, methodology and participant characteristics of a randomized controlled trial designed to: (1) determine which pharmacotherapy - NRT, long term combinations of NRT, or varenicline - is most effective in achieving abstinence; (2) investigate the incidence of neuropsychiatric symptoms among participants over the course of their quit attempt; and (3) assess whether there is a significant difference in the incidence of neuropsychiatric symptoms in those receiving differing pharmacotherapies, and between those with and without psychiatric illnesses. The primary outcome was carbon monoxide confirmed abstinence from weeks 5-52 following a target quit date. Secondary outcomes included neuropsychiatric (i.e., depression, suicidal ideation, anxiety, anger) and withdrawal symptoms. Smokers (N=737) were randomly assigned to one of three treatment conditions, and were scheduled to attend 8 follow-up appointments over 12 months. All participants received 6-15 minute practical counseling sessions with nurse counselors experienced in treating tobacco dependence. We expect that the results will lead to an enhanced understanding of the efficacy of these pharmacotherapies, including those with a history of psychiatric illness.
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Affiliation(s)
- Heather Tulloch
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada.
| | - Andrew Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Charl Els
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Debbie Aitken
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Matthew Clyde
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada; School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Brigitte Corran
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Robert D Reid
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Abstract
Cigarette smoking is a major preventable cause of morbidity and mortality. It is the major risk factor for chronic obstructive pulmonary disease in the developed world. Smoking is a chronic relapsing disease. Optimal treatment includes nonpharmacologic support, together with pharmacotherapy. All clinicians should be comfortable with the use of nicotine replacement therapy, bupropion, and varenicline. Second-line therapies can be used by those familiar with their use. Effective use of these medications requires their integration into an effective management plan, which is likely to be a long-term undertaking, involving several cycles of remission and relapse.
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Affiliation(s)
- Stephen I Rennard
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Nebraska Medical Center, 985910 Nebraska Medical Center, Omaha, Nebraska 68198-5910, USA.
| | - David M Daughton
- Division of Pulmonary, Critical Care, Sleep and Allergy, University of Nebraska Medical Center, 985910 Nebraska Medical Center, Omaha, Nebraska 68198-5910, USA
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93
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Jennings C, Kotseva K, De Bacquer D, Hoes A, de Velasco J, Brusaferro S, Mead A, Jones J, Tonstad S, Wood D. Effectiveness of a preventive cardiology programme for high CVD risk persistent smokers: the EUROACTION PLUS varenicline trial. Eur Heart J 2014; 35:1411-20. [DOI: 10.1093/eurheartj/ehu051] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Catriona Jennings
- Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK
| | - Kornelia Kotseva
- Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK
| | - Dirk De Bacquer
- Unit of Epidemiology and Preventive Medicine, Department of Public Health, Ghent University, Gent 9000, Belgium
| | - Arno Hoes
- University Medical Center Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands
| | - Jose de Velasco
- Servicio Cardiologie, Hospital General Universitario, Valencia, Spain
| | - Silvio Brusaferro
- Department of Medical and Biological Sciences, University of Udine, AOUD S M Della Miserciordi Udine, Italy
| | - Alison Mead
- Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK
| | - Jennifer Jones
- Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK
| | - Serena Tonstad
- Department of Preventive Cardiology, Oslo University Hospital, Ullevål, Oslo N-0407, Norway
| | - David Wood
- Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London (St Mary's Campus), International Centre for Circulatory Health, London W2 1LA, UK
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Aubin HJ, Luquiens A, Berlin I. Pharmacotherapy for smoking cessation: pharmacological principles and clinical practice. Br J Clin Pharmacol 2014; 77:324-36. [PMID: 23488726 PMCID: PMC4014023 DOI: 10.1111/bcp.12116] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 02/11/2013] [Indexed: 11/30/2022] Open
Abstract
Strategies for assisting smoking cessation include behavioural counselling to enhance motivation and to support attempts to quit and pharmacological intervention to reduce nicotine reinforcement and withdrawal from nicotine. Three drugs are currently used as first line pharmacotherapy for smoking cessation, nicotine replacement therapy, bupropion and varenicline. Compared with placebo, the drug effect varies from 2.27 (95% CI 2.02, 2.55) for varenicline, 1.69 (95% CI 1.53, 1.85) for bupropion and 1.60 (95% CI 1.53, 1.68) for any form of nicotine replacement therapy. Despite some controversy regarding the safety of bupropion and varenicline, regulatory agencies consider these drugs as having a favourable benefit/risk profile. However, given the high rate of psychiatric comorbidity in dependent smokers, practitioners should closely monitor patients for neuropsychiatric symptoms. Second-line pharmacotherapies include nortriptyline and clonidine. This review also offers an overview of pipeline developments and issues related to smoking cessation in special populations such as persons with psychiatric comorbidity and pregnant and adolescent smokers.
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Affiliation(s)
- Henri-Jean Aubin
- Centre d'enseignement, de recherche, et de traitement des addictions, Hôpital Paul Brousse, Pars-Sud 11 UniversityINSERM U669, 94800, Villejuif, France
| | - Amandine Luquiens
- Centre d'enseignement, de recherche, et de traitement des addictions, Hôpital Paul Brousse, Pars-Sud 11 UniversityINSERM U669, 94800, Villejuif, France
| | - Ivan Berlin
- Département de Pharmacologie, Université P.&M. Curie, Faculté de médecine, Hôpital Pitié-Salpêtrière75013, Paris, France
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95
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Rüther T, Bobes J, De Hert M, Svensson T, Mann K, Batra A, Gorwood P, Möller H. EPA Guidance on Tobacco Dependence and Strategies for Smoking Cessation in People with Mental Illness. Eur Psychiatry 2014; 29:65-82. [DOI: 10.1016/j.eurpsy.2013.11.002] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 11/13/2013] [Accepted: 11/13/2013] [Indexed: 12/16/2022] Open
Abstract
AbstractTobacco dependence is the most common substance use disorder in adults with mental illness. The prevalence rates for tobacco dependence are two to four times higher in these patients than in the general population. Smoking has a strong, negative influence on the life expectancy and quality of life of mental health patients, and remains the leading preventable cause of death in this group. Despite these statistics, in some countries smokers with mental illness are disadvantaged in receiving intervention and support for their tobacco dependence, which is often overlooked or even tolerated. This statement from the European Psychiatric Association (EPA) systematically reviews the current evidence on tobacco dependence and withdrawal in patients with mental illness and their treatment. It provides seven recommendations for the core components of diagnostics and treatment in this patient group. These recommendations concern: (1) the recording process, (2) the timing of the intervention, (3) counselling specificities, (4) proposed treatments, (5) frequency of contact after stopping, (6) follow-up visits and (7) relapse prevention. They aim to help clinicians improve the care, health and well-being of patients suffering from mental illness.
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96
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Rollema H, Russ C, Lee TC, Hurst RS, Bertrand D. Functional interactions of varenicline and nicotine with nAChR subtypes implicated in cardiovascular control. Nicotine Tob Res 2014; 16:733-42. [PMID: 24406270 DOI: 10.1093/ntr/ntt208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION It has been suggested that varenicline-induced activation of nicotinic acetylcholine receptors (nAChRs) could play a role in the cardiovascular (CV) safety of varenicline. However, since preclinical studies showed that therapeutic varenicline concentrations have no effect in models of CV function, this study examined in vitro profiles of varenicline and nicotine at nAChR subtypes possibly involved in CV control. METHODS Concentration-dependent functional effects of varenicline and nicotine at human α3β4, α3α5β4, α7, and α4β2 nAChRs expressed in oocytes were determined by electrophysiology. The proportion of nAChRs predicted to be activated and inhibited by concentrations of varenicline (1mg b.i.d.) and of nicotine in smokers was derived from activation-inhibition curves for each nAChR subtype. RESULTS Human varenicline and nicotine concentrations can desensitize and inhibit nAChRs but cause only low-level activation of α3β4, α4β2 (<2%), α7 (<0.05%), and α3α5β4 (<0.01%) nAChRs, which is consistent with literature data. Nicotine concentrations in smokers are predicted to inhibit larger fractions of α3β4 (48%) and α3α5β4 (10%) nAChRs than therapeutic varenicline concentrations (11% and 0.6%, respectively) and to inhibit comparable fractions of α4β2 nAChRs (42%-56%) and α7 nAChRs (16%) as varenicline. CONCLUSIONS Nicotine and varenicline concentrations in patients and smokers are predicted to cause minimal activation of ganglionic α3β4* nAChRs, while their functional profiles at α3β4, α3α5β4, α7, and α4β2 nAChRs cannot explain that substituting nicotine from tobacco with varenicline would cause CV adverse events in smokers who try to quit. Other pharmacological properties that could mediate varenicline-induced CV effects have not been identified.
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97
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Mills EJ, Thorlund K, Eapen S, Wu P, Prochaska JJ. Cardiovascular events associated with smoking cessation pharmacotherapies: a network meta-analysis. Circulation 2014; 129:28-41. [PMID: 24323793 PMCID: PMC4258065 DOI: 10.1161/circulationaha.113.003961] [Citation(s) in RCA: 273] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 10/10/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Stopping smoking is associated with many important improvements in health and quality of life. The use of cessation medications is recommended to increase the likelihood of quitting. However, there is historical and renewed concern that smoking cessation therapies may increase the risk of cardiovascular disease events associated within the quitting period. We aimed to examine whether the 3 licensed smoking cessation therapies-nicotine replacement therapy, bupropion, and varenicline-were associated with an increased risk of cardiovascular disease events using a network meta-analysis. METHODS AND RESULTS We searched 10 electronic databases, were in communication with authors of published randomized, clinical trials (RCTs), and accessed internal US Food and Drug Administration reports. We included any RCT of the 3 treatments that reported cardiovascular disease outcomes. Among 63 eligible RCTs involving 21 nicotine replacement therapy RCTs, 28 bupropion RCTs, and 18 varenicline RCTs, we found no increase in the risk of all cardiovascular disease events with bupropion (relative risk [RR], 0.98; 95% confidence interval [CI], 0.54-1.73) or varenicline (RR, 1.30; 95% CI, 0.79-2.23). There was an elevated risk associated with nicotine replacement therapy that was driven predominantly by less serious events (RR, 2.29; 95% CI, 1.39-3.82). When we examined major adverse cardiovascular events, we found a protective effect with bupropion (RR, 0.45; 95% CI, 0.21-0.85) and no clear evidence of harm with varenicline (RR, 1.34; 95% CI, 0.66-2.66) or nicotine replacement therapy (RR, 1.95; 95% CI, 0.26-4.30). CONCLUSION Smoking cessation therapies do not appear to raise the risk of serious cardiovascular disease events.
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Affiliation(s)
- Edward J Mills
- Stanford Prevention Research Center, Stanford University, Stanford, CA (E.J.M., K.T., J.J.P.); Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada (E.J.M., S.E., P.W.); and Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada (K.T.)
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98
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Abstract
One in three adults in India uses tobacco, a highly addictive substance in one or other form. In addition to prevention of tobacco use, offering evidence-based cessation services to dependent tobacco users constitutes an important approach in addressing this serious public health problem. A combination of behavioral methods and pharmacotherapy has shown the most optimal results in tobacco dependence treatment. Among currently available pharmacological agents, drugs that preferentially act on the α4 β2-nicotinic acetyl choline receptor like varenicline and cytisine appear to have relatively better cessation outcomes. These drugs are in general well tolerated and have minimal drug interactions. The odds of quitting tobacco use are at the very least doubled with the use of partial agonists compared with placebo and the outcomes are also superior when compared to nicotine replacement therapy and bupropion. The poor availability of partial agonists and specifically the cost of varenicline, as well as the lack of safety data for cytisine has limited their use world over, particularly in developing countries. Evidence for the benefit of partial agonists is more robust for smoking rather than smokeless forms of tobacco. Although more studies are needed to demonstrate their effectiveness in different populations of tobacco users, present literature supports the use of partial agonists in addition to behavioral methods for optimal outcome in tobacco dependence.
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Affiliation(s)
- Nivedita Maity
- Department of Pharmacology, M S Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Prabhat Chand
- Department of Psychiatry, Centre for Addiction Medicine and Tobacco Cessation Centre, NIMHANS, Bengaluru, Karnataka, India
| | - Pratima Murthy
- Department of Psychiatry, Centre for Addiction Medicine and Tobacco Cessation Centre, NIMHANS, Bengaluru, Karnataka, India
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99
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Jain R, Jhanjee S, Jain V, Gupta T, Mittal S, Goelz P, Wileyto EP, Schnoll RA. A double-blind placebo-controlled randomized trial of varenicline for smokeless tobacco dependence in India. Nicotine Tob Res 2014; 16:50-7. [PMID: 23946326 PMCID: PMC3864491 DOI: 10.1093/ntr/ntt115] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 06/25/2013] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The rate of smokeless tobacco use in India is 20%; its use causes serious health problems, and no trial has assessed behavioral or pharmacological treatments for this public health concern. This trial evaluated varenicline for treating smokeless tobacco dependence in India. METHODS This was a double-blind placebo-controlled randomized trial of varenicline (12 weeks, 1mg, twice per day) with 237 smokeless tobacco users in India. All participants received behavioral counseling. Outcomes included self-reported and biochemically verified abstinence at the end of treatment (EOT), lapse and recovery events, safety, and medication adherence. RESULTS Self-reported EOT abstinence was significantly greater for varenicline (43%) versus placebo (31%; adjusted odds ratio [AOR] = 2.6, 95% CI = 1.2-4.2, p = .009). Biochemically confirmed EOT abstinence was greater for varenicline versus placebo (25.2% vs. 19.5%), but this was not statistically different (AOR = 1.6, 95% CI = 0.84-3.1, p = .15). Compared with placebo, varenicline did not reduce the risk for a lapse (hazard ratio [HR] = 0.86, 95% CI = 0.69-1.1, p = .14), but it did increase the likelihood of recovery to abstinence (HR = 1.2, 95% CI = 1.02-1.4, p = .02). Greater adherence increased EOT cessation rates for varenicline (39% vs. 18%, p = .003) but not for placebo (28% vs. 14%, p = .06). There were no significant differences between varenicline and placebo in rate of side effects, serious adverse events, hypertension, or stopping or reducing medication. CONCLUSIONS Varenicline is safe for treating smokeless tobacco dependence in India, and further examination of this medication for this important public health problem is warranted.
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Affiliation(s)
- Raka Jain
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sonali Jhanjee
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Veena Jain
- Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Tina Gupta
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Swati Mittal
- Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Patricia Goelz
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - E. Paul Wileyto
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Robert A. Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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100
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Rackham DM, C Herink M, Stevens IG, Cardoza NM, Singh H. Evidence behind FDA alerts for drugs with adverse cardiovascular effects: implications for clinical practice. Pharmacotherapy 2013; 34:358-72. [PMID: 24347043 DOI: 10.1002/phar.1381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The U.S. Food and Drug Administration (FDA) periodically publishes Drug Safety Communications and Drug Alerts notifying health care practitioners and the general public of important information regarding drug therapies following FDA approval. These alerts can result in both positive and negative effects on patient care. Most clinical trials are not designed to detect long-term safety end points, and postmarketing surveillance along with patient reported events are often instrumental in signaling the potential harmful effect of a drug. Recently, many cardiovascular (CV) safety announcements have been released for FDA-approved drugs. Because a premature warning could discourage a much needed treatment or prompt a sudden discontinuation, it is essential to evaluate the evidence supporting these FDA alerts to provide effective patient care and to avoid unwarranted changes in therapy. Conversely, paying attention to these warnings in cases involving high-risk patients can prevent adverse effects and litigation. This article reviews the evidence behind recent FDA alerts for drugs with adverse CV effects and discusses the clinical practice implications.
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Affiliation(s)
- Daniel M Rackham
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health & Science University, Corvallis, Oregon
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