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Yu T, Yang X, Clark J, Lin L, Furuya-Kanamori L, Xu C. Accelerating evidence synthesis for safety assessment through ClinicalTrials.gov platform: a feasibility study. BMC Med Res Methodol 2024; 24:165. [PMID: 39080524 PMCID: PMC11290241 DOI: 10.1186/s12874-024-02225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/18/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Standard systematic review can be labor-intensive and time-consuming meaning that it can be difficult to provide timely evidence when there is an urgent public health emergency such as a pandemic. The ClinicalTrials.gov provides a promising way to accelerate evidence production. METHODS We conducted a search on PubMed to gather systematic reviews containing a minimum of 5 studies focused on safety aspects derived from randomized controlled trials (RCTs) of pharmacological interventions, aiming to establish a real-world dataset. The registration information of each trial from eligible reviews was further collected and verified. The meta-analytic data were then re-analyzed by using 1) the full meta-analytic data with all trials and 2) emulated rapid data with trials that had been registered and posted results on ClinicalTrials.gov, under the same synthesis methods. The effect estimates of the full meta-analysis and rapid meta-analysis were then compared. RESULTS The real-world dataset comprises 558 meta-analyses. Among them, 56 (10.0%) meta-analyses included RCTs that were not registered in ClinicalTrials.gov. For the remaining 502 meta-analyses, the median percentage of RCTs registered within each meta-analysis is 70.1% (interquartile range: 33.3% to 88.9%). Under a 20% bias threshold, rapid meta-analyses conducted through ClinicalTrials.gov achieved accurate point estimates ranging from 77.4% (using the MH model) to 83.1% (using the GLMM model); 91.0% to 95.3% of these analyses accurately predicted the direction of effects. CONCLUSIONS Utilizing the ClinicalTrials.gov platform for safety assessment with a minimum of 5 RCTs holds significant potential for accelerating evidence synthesis to support urgent decision-making.
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Affiliation(s)
- Tianqi Yu
- Center of Research in Epidemiology and Statistics, Université Paris Cité, Inserm, Paris, France
| | - Xi Yang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Lifeng Lin
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, The University of Queensland, Herston, Australia
| | - Chang Xu
- Proof of Concept Center, Eastern Hepatobiliary Surgery Hospital, Third Affiliated Hospital, Second Military Medical University, Naval Medical University, Shanghai, China.
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Noma H, Sugasawa S, Furukawa TA. Robust inference methods for meta-analysis involving influential outlying studies. Stat Med 2024. [PMID: 38899515 DOI: 10.1002/sim.10157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 04/21/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
Meta-analysis is an essential tool to comprehensively synthesize and quantitatively evaluate results of multiple clinical studies in evidence-based medicine. In many meta-analyses, the characteristics of some studies might markedly differ from those of the others, and these outlying studies can generate biases and potentially yield misleading results. In this article, we provide effective robust statistical inference methods using generalized likelihoods based on the density power divergence. The robust inference methods are designed to adjust the influences of outliers through the use of modified estimating equations based on a robust criterion, even when multiple and serious influential outliers are present. We provide the robust estimators, statistical tests, and confidence intervals via the generalized likelihoods for the fixed-effect and random-effects models of meta-analysis. We also assess the contribution rates of individual studies to the robust overall estimators that indicate how the influences of outlying studies are adjusted. Through simulations and applications to two recently published systematic reviews, we demonstrate that the overall conclusions and interpretations of meta-analyses can be markedly changed if the robust inference methods are applied and that only the conventional inference methods might produce misleading evidence. These methods would be recommended to be used at least as a sensitivity analysis method in the practice of meta-analysis. We have also developed an R package, robustmeta, that implements the robust inference methods.
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Affiliation(s)
- Hisashi Noma
- Department of Interdisciplinary Statistical Mathematics, The Institute of Statistical Mathematics, Tokyo, Japan
- The Graduate Institute for Advanced Studies, The Graduate University for Advanced Studies (SOKENDAI), Tokyo, Japan
| | | | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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Chenoweth MJ, Kim YJ, Nollen NL, Hawk LW, Mahoney MC, Lerman C, Knight J, Tyndale RF. Genetic Prediction of Smoking Cessation Medication Side Effects: A Genome-Wide Investigation of Abnormal Dreams on Varenicline. Clin Pharmacol Ther 2024; 115:1277-1281. [PMID: 38369951 DOI: 10.1002/cpt.3210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/26/2024] [Indexed: 02/20/2024]
Abstract
Varenicline, the most efficacious smoking cessation monotherapy, produces abnormal dreams. Although genetic contributions to varenicline-associated nausea and cessation have been identified, the role of genetics in abnormal dreams is unknown. We conducted a genomewide association study (GWAS) of abnormal dreams in 188 European ancestry smokers treated with varenicline (NCT01314001). Additive genetic models examined the likelihood of experiencing abnormal dreams 2 weeks following varenicline initiation. For the top locus, we tested for selectivity to varenicline, effects on cessation, replication, and generalizability to African ancestry (AA) individuals. The top GWAS variant associated with abnormal dreams was rs901886, mapping to intron 2 of ICAM5 on chromosome 19. The prevalence of abnormal dreams in those with rs901886 CC, CT, and TT genotypes was 15%, 36%, and 62%, respectively (odds ratio = 2.94 for T vs. C, 95% confidence interval = 1.92-4.55, P = 2.03e-7; T allele frequency = 52%). This rs901886 association was selective to varenicline (P values > 0.05 on nicotine patch and placebo). There were also positive associations for rs901886 T (vs. C allele, P = 0.03) and for abnormal dreams (P = 0.06) with varenicline-aided cessation. Neither rs901886 (P = 0.40) nor abnormal dreams (P = 0.24) were associated with adherence. A similar direction of effect of rs901886 on abnormal dreams was observed in a second varenicline trial (NCT01836276). In AA individuals (n = 137), rs901886 was not associated with abnormal dreams (P = 0.41), but there was an association for a variant located ~ 74.4 kb 5' of ICAM5 (P = 2.56e-3). Variation in ICAM5 may influence abnormal dreams and cessation on varenicline. These findings provide additional support for genetically optimized smoking cessation approaches.
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Affiliation(s)
- Meghan J Chenoweth
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Yong Jae Kim
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Nikki L Nollen
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Larry W Hawk
- Department of Psychology, University at Buffalo, Buffalo, New York, USA
| | - Martin C Mahoney
- Department of Internal Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Caryn Lerman
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jo Knight
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Data Science Institute, Lancaster University Medical School, Lancaster, UK
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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4
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Agrawal S, Evison M, Ananth S, Fullerton D, McDill H, Perry M, Pollington J, Restrick L, Spencer E, Vaghela A. Medical management of inpatients with tobacco dependency. Thorax 2024; 79:3-11. [PMID: 38531603 DOI: 10.1136/thorax-2023-220607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Affiliation(s)
- Sanjay Agrawal
- Department of Respiratory Medicine, Glenfield Hospital, Institute for Lung Health, Leicester, UK
| | - Matthew Evison
- Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre (MAHSC), Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Duncan Fullerton
- Mid Cheshire Hospitals NHS Foundation Trust, Crewe, Cheshire, UK
| | | | | | | | - Louise Restrick
- Department of Respiratory Medicine, Whittington Health, London, UK
| | - Elspeth Spencer
- University Hospitals Derby & Burton NHS Foundation Trust, Burton Upon Trent, UK
| | - Ameet Vaghela
- Adur Health Partnership, Shoreham and Southwick Primary Care Network, Shoreham, UK
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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). This is an update of a Cochrane Review first published in 2007. Objectives To assess the effectiveness of nicotine receptor partial agonists, including varenicline and cytisine, for smoking cessation. Search methods We searched the Cochrane Tobacco Addiction Group's Specialised Register in April 2022 for trials, using relevant terms in the title or abstract, or as keywords. The register is compiled from searches of CENTRAL, MEDLINE, Embase, and PsycINFO. Selection criteria We included randomised controlled trials that compared the treatment drug with placebo, another smoking cessation drug, e‐cigarettes, or no medication. We excluded trials that did not report a minimum follow‐up period of six months from baseline. Data collection and analysis We followed standard Cochrane methods. Our main outcome was abstinence from smoking at longest follow‐up using the most rigorous definition of abstinence, preferring biochemically validated rates where reported. We pooled risk ratios (RRs), using the Mantel‐Haenszel fixed‐effect model. We also reported the number of people reporting serious adverse events (SAEs). Main results We included 75 trials of 45,049 people; 45 were new for this update. We rated 22 at low risk of bias, 18 at high risk, and 35 at unclear risk. We found moderate‐certainty evidence (limited by heterogeneity) that cytisine helps more people to quit smoking than placebo (RR 1.30, 95% confidence interval (CI) 1.15 to 1.47; I2 = 83%; 4 studies, 4623 participants), and no evidence of a difference in the number reporting SAEs (RR 1.04, 95% CI 0.78 to 1.37; I2 = 0%; 3 studies, 3781 participants; low‐certainty evidence). SAE evidence was limited by imprecision. We found no data on neuropsychiatric or cardiac SAEs. We found high‐certainty evidence that varenicline helps more people to quit than placebo (RR 2.32, 95% CI 2.15 to 2.51; I2 = 60%, 41 studies, 17,395 participants), and moderate‐certainty evidence that people taking varenicline are more likely to report SAEs than those not taking it (RR 1.23, 95% CI 1.01 to 1.48; I2 = 0%; 26 studies, 14,356 participants). While point estimates suggested increased risk of cardiac SAEs (RR 1.20, 95% CI 0.79 to 1.84; I2 = 0%; 18 studies, 7151 participants; low‐certainty evidence), and decreased risk of neuropsychiatric SAEs (RR 0.89, 95% CI 0.61 to 1.29; I2 = 0%; 22 studies, 7846 participants; low‐certainty evidence), in both cases evidence was limited by imprecision, and confidence intervals were compatible with both benefit and harm. Pooled results from studies that randomised people to receive cytisine or varenicline found no clear evidence of difference in quit rates (RR 1.00, 95% CI 0.79 to 1.26; I2 = 65%; 2 studies, 2131 participants; low‐certainty evidence) and reported SAEs (RR 0.67, 95% CI 0.44 to 1.03; I2 = 45%; 2 studies, 2017 participants; low‐certainty evidence). However, the evidence was limited by imprecision, and confidence intervals incorporated the potential for benefit from either cytisine or varenicline. We found no data on neuropsychiatric or cardiac SAEs. We found high‐certainty evidence that varenicline helps more people to quit than bupropion (RR 1.36, 95% CI 1.25 to 1.49; I2 = 0%; 9 studies, 7560 participants), and no clear evidence of difference in rates of SAEs (RR 0.89, 95% CI 0.61 to 1.31; I2 = 0%; 5 studies, 5317 participants), neuropsychiatric SAEs (RR 1.05, 95% CI 0.16 to 7.04; I2 = 10%; 2 studies, 866 participants), or cardiac SAEs (RR 3.17, 95% CI 0.33 to 30.18; I2 = 0%; 2 studies, 866 participants). Evidence of harms was of low certainty, limited by imprecision. We found high‐certainty evidence that varenicline helps more people to quit than a single form of nicotine replacement therapy (NRT) (RR 1.25, 95% CI 1.14 to 1.37; I2 = 28%; 11 studies, 7572 participants), and low‐certainty evidence, limited by imprecision, of fewer reported SAEs (RR 0.70, 95% CI 0.50 to 0.99; I2 = 24%; 6 studies, 6535 participants). We found no data on neuropsychiatric or cardiac SAEs. We found no clear evidence of a difference in quit rates between varenicline and dual‐form NRT (RR 1.02, 95% CI 0.87 to 1.20; I2 = 0%; 5 studies, 2344 participants; low‐certainty evidence, downgraded because of imprecision). While pooled point estimates suggested increased risk of SAEs (RR 2.15, 95% CI 0.49 to 9.46; I2 = 0%; 4 studies, 1852 participants) and neuropsychiatric SAEs (RR 4.69, 95% CI 0.23 to 96.50; I2 not estimable as events only in 1 study; 2 studies, 764 participants), and reduced risk of cardiac SAEs (RR 0.32, 95% CI 0.01 to 7.88; I2 not estimable as events only in 1 study; 2 studies, 819 participants), in all three cases evidence was of low certainty and confidence intervals were very wide, encompassing both substantial harm and benefit. Authors' conclusions Cytisine and varenicline both help more people to quit smoking than placebo or no medication. Varenicline is more effective at helping people to quit smoking than bupropion, or a single form of NRT, and may be as or more effective than dual‐form NRT. People taking varenicline are probably more likely to experience SAEs than those not taking it, and while there may be increased risk of cardiac SAEs and decreased risk of neuropsychiatric SAEs, evidence was compatible with both benefit and harm. Cytisine may lead to fewer people reporting SAEs than varenicline. Based on studies that directly compared cytisine and varenicline, there may be no difference or a benefit from either medication for quitting smoking. Future trials should test the effectiveness and safety of cytisine compared with varenicline and other pharmacotherapies, and should also test variations in dose and duration. There is limited benefit to be gained from more trials testing the effect of standard‐dose varenicline compared with placebo for smoking cessation. Further trials on varenicline should test variations in dose and duration, and compare varenicline with e‐cigarettes for smoking cessation. Can medications like varenicline and cytisine (nicotine receptor partial agonists) help people to stop smoking and do they cause unwanted effects? Key messages · Varenicline can help people to stop smoking for at least 6 months. Evidence shows it works better than bupropion and using only one type of nicotine replacement therapy (e.g. only patches). Quit rates might be similar to using more than one type of nicotine replacement therapy at the same time (e.g. patches and gum together). · Cytisine can help people to stop smoking for at least 6 months. It may work as well as varenicline, but future evidence may show that while it helps, it is not quite as helpful as varenicline. · Future studies should test the effectiveness and safety of cytisine compared with varenicline and other stop‐smoking medications, and should also investigate giving cytisine or varenicline at different doses and for different lengths of time. What are 'nicotine receptor partial agonists'? Smoking tobacco is extremely bad for people’s health. For people who smoke, quitting is the best thing they can do to improve their health. Many people find it difficult to quit smoking. Nicotine receptor partial agonists (NRPAs) are a type of medication used to help people to stop smoking. They help to reduce the withdrawal symptoms people experience when they stop smoking, like cravings and unpleasant mood changes. They also reduce the pleasure people usually experience when they smoke. The most widely‐available treatment in this drug type is varenicline. Cytisine is another, similar medication. They may cause unwanted effects such as feeling sick (nausea) and other stomach problems, difficulties sleeping, abnormal dreams, and headache. They may also lead to potentially serious unwanted effects, such as suicidal thoughts, heart problems and raised blood pressure. What did we want to find out? We wanted to find out if using NRPAs can help people to quit smoking, and if they cause unwanted effects. We wanted to know: · how many people stopped smoking for at least 6 months; and · how many people had unwanted effects. What did we do? We searched for studies that investigated NRPAs used to help people quit smoking. People in the studies had to be chosen at random to receive an NRPA, or another NRPA, placebo (medication like the NRPA but with no active ingredients) or no treatment. They had to be adult tobacco smokers who wanted to stop smoking. What did we find? We found 75 studies that compared NRPAs with: · placebo or no medicine; · nicotine replacement therapy, such as patches or gum; · bupropion (another medicine to help people stop smoking); · another NRPA; · e‐cigarettes. The USA hosted the most studies (28 studies). Other studies took place in a range of countries across the world, some in several countries. Main results People are more likely to stop smoking for at least six months using varenicline than using placebo (41 studies, 17,395 people), bupropion (9 studies, 7560 people), or just one type of nicotine replacement therapy, like patches alone (11 studies, 7572 people). They may be just as likely to quit as people using two or more kinds of nicotine replacement therapy, like patches and gum together (5 studies, 2344 people). Cytisine probably helps more people to stop smoking than placebo (4 studies, 4623 people) and may be just as effective as varenicline (2 studies, 2131 people). For every 100 people using varenicline to stop smoking, 21 to 25 might successfully stop, compared with only 18 of 100 people using bupropion, 18 of 100 people using a single form of nicotine‐replacement therapy, and 20 of 100 using two or more kinds of nicotine‐replacement therapy. For every 100 people using cytisine to stop smoking, 18 to 23 might successfully stop. The most common unwanted effect of varenicline is nausea, but this is mostly at mild or moderate levels and usually clears over time. People taking varenicline likely have an increased chance of a more serious unwanted effect that could result in going to hospital, however these are still rare (2.7% to 4% of people on varenicline, compared with 2.7% of people without) and may include many that are unrelated to varenicline. People taking cytisine may also have a slightly increased chance of serious unwanted effects compared with people not taking it, but this may be less likely compared with varenicline. What are the limitations of the evidence? The evidence for some of our results is very reliable. We’re very confident that varenicline helps people to quit smoking better than many alternatives. We’re less sure of some other results because fewer or smaller studies provided evidence. Several results suggest one treatment is better or less harmful than another, but the opposite could still be true. How up to date is the evidence? The evidence is up to date to 29 April 2022.
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Livingstone-Banks J, Fanshawe TR, Thomas KH, Theodoulou A, Hajizadeh A, Hartman L, Lindson N. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev 2023; 5:CD006103. [PMID: 37142273 PMCID: PMC10169257 DOI: 10.1002/14651858.cd006103.pub8] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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). This is an update of a Cochrane Review first published in 2007. OBJECTIVES To assess the effectiveness of nicotine receptor partial agonists, including varenicline and cytisine, for smoking cessation. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register in April 2022 for trials, using relevant terms in the title or abstract, or as keywords. The register is compiled from searches of CENTRAL, MEDLINE, Embase, and PsycINFO. SELECTION CRITERIA: We included randomised controlled trials that compared the treatment drug with placebo, another smoking cessation drug, e-cigarettes, or no medication. We excluded trials that did not report a minimum follow-up period of six months from baseline. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. Our main outcome was abstinence from smoking at longest follow-up using the most rigorous definition of abstinence, preferring biochemically validated rates where reported. We pooled risk ratios (RRs), using the Mantel-Haenszel fixed-effect model. We also reported the number of people reporting serious adverse events (SAEs). MAIN RESULTS We included 75 trials of 45,049 people; 45 were new for this update. We rated 22 at low risk of bias, 18 at high risk, and 35 at unclear risk. We found moderate-certainty evidence (limited by heterogeneity) that cytisine helps more people to quit smoking than placebo (RR 1.30, 95% confidence interval (CI) 1.15 to 1.47; I2 = 83%; 4 studies, 4623 participants), and no evidence of a difference in the number reporting SAEs (RR 1.04, 95% CI 0.78 to 1.37; I2 = 0%; 3 studies, 3781 participants; low-certainty evidence). SAE evidence was limited by imprecision. We found no data on neuropsychiatric or cardiac SAEs. We found high-certainty evidence that varenicline helps more people to quit than placebo (RR 2.32, 95% CI 2.15 to 2.51; I2 = 60%, 41 studies, 17,395 participants), and moderate-certainty evidence that people taking varenicline are more likely to report SAEs than those not taking it (RR 1.23, 95% CI 1.01 to 1.48; I2 = 0%; 26 studies, 14,356 participants). While point estimates suggested increased risk of cardiac SAEs (RR 1.20, 95% CI 0.79 to 1.84; I2 = 0%; 18 studies, 7151 participants; low-certainty evidence), and decreased risk of neuropsychiatric SAEs (RR 0.89, 95% CI 0.61 to 1.29; I2 = 0%; 22 studies, 7846 participants; low-certainty evidence), in both cases evidence was limited by imprecision, and confidence intervals were compatible with both benefit and harm. Pooled results from studies that randomised people to receive cytisine or varenicline showed that more people in the varenicline arm quit smoking (RR 0.83, 95% CI 0.66 to 1.05; I2 = 0%; 2 studies, 2131 participants; moderate-certainty evidence) and reported SAEs (RR 0.67, 95% CI 0.44 to 1.03; I2 = 45%; 2 studies, 2017 participants; low-certainty evidence). However, the evidence was limited by imprecision, and confidence intervals incorporated the potential for benefit from either cytisine or varenicline. We found no data on neuropsychiatric or cardiac SAEs. We found high-certainty evidence that varenicline helps more people to quit than bupropion (RR 1.36, 95% CI 1.25 to 1.49; I2 = 0%; 9 studies, 7560 participants), and no clear evidence of difference in rates of SAEs (RR 0.89, 95% CI 0.61 to 1.31; I2 = 0%; 5 studies, 5317 participants), neuropsychiatric SAEs (RR 1.05, 95% CI 0.16 to 7.04; I2 = 10%; 2 studies, 866 participants), or cardiac SAEs (RR 3.17, 95% CI 0.33 to 30.18; I2 = 0%; 2 studies, 866 participants). Evidence of harms was of low certainty, limited by imprecision. We found high-certainty evidence that varenicline helps more people to quit than a single form of nicotine replacement therapy (NRT) (RR 1.25, 95% CI 1.14 to 1.37; I2 = 28%; 11 studies, 7572 participants), and low-certainty evidence, limited by imprecision, of fewer reported SAEs (RR 0.70, 95% CI 0.50 to 0.99; I2 = 24%; 6 studies, 6535 participants). We found no data on neuropsychiatric or cardiac SAEs. We found no clear evidence of a difference in quit rates between varenicline and dual-form NRT (RR 1.02, 95% CI 0.87 to 1.20; I2 = 0%; 5 studies, 2344 participants; low-certainty evidence, downgraded because of imprecision). While pooled point estimates suggested increased risk of SAEs (RR 2.15, 95% CI 0.49 to 9.46; I2 = 0%; 4 studies, 1852 participants) and neuropsychiatric SAEs (RR 4.69, 95% CI 0.23 to 96.50; I2 not estimable as events only in 1 study; 2 studies, 764 participants), and reduced risk of cardiac SAEs (RR 0.32, 95% CI 0.01 to 7.88; I2 not estimable as events only in 1 study; 2 studies, 819 participants), in all three cases evidence was of low certainty and confidence intervals were very wide, encompassing both substantial harm and benefit. AUTHORS' CONCLUSIONS Cytisine and varenicline both help more people to quit smoking than placebo or no medication. Varenicline is more effective at helping people to quit smoking than bupropion, or a single form of NRT, and may be as or more effective than dual-form NRT. People taking varenicline are probably more likely to experience SAEs than those not taking it, and while there may be increased risk of cardiac SAEs and decreased risk of neuropsychiatric SAEs, evidence was compatible with both benefit and harm. Cytisine may lead to fewer people reporting SAEs than varenicline. Based on studies that directly compared cytisine and varenicline, there may be a benefit from varenicline for quitting smoking, however further evidence could strengthen this finding or demonstrate a benefit from cytisine. Future trials should test the effectiveness and safety of cytisine compared with varenicline and other pharmacotherapies, and should also test variations in dose and duration. There is limited benefit to be gained from more trials testing the effect of standard-dose varenicline compared with placebo for smoking cessation. Further trials on varenicline should test variations in dose and duration, and compare varenicline with e-cigarettes for smoking cessation.
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Affiliation(s)
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kyla H Thomas
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anisa Hajizadeh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lilian Hartman
- University of Oxford Medical School, John Radcliffe Hospital, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Karapetian K, Jeon SM, Kwon JW, Suh YK. Supervised Relation Extraction Between Suicide-Related Entities and Drugs: Development and Usability Study of an Annotated PubMed Corpus. J Med Internet Res 2023; 25:e41100. [PMID: 36884281 PMCID: PMC10034613 DOI: 10.2196/41100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 11/18/2022] [Accepted: 12/19/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Drug-induced suicide has been debated as a crucial issue in both clinical and public health research. Published research articles contain valuable data on the drugs associated with suicidal adverse events. An automated process that extracts such information and rapidly detects drugs related to suicide risk is essential but has not been well established. Moreover, few data sets are available for training and validating classification models on drug-induced suicide. OBJECTIVE This study aimed to build a corpus of drug-suicide relations containing annotated entities for drugs, suicidal adverse events, and their relations. To confirm the effectiveness of the drug-suicide relation corpus, we evaluated the performance of a relation classification model using the corpus in conjunction with various embeddings. METHODS We collected the abstracts and titles of research articles associated with drugs and suicide from PubMed and manually annotated them along with their relations at the sentence level (adverse drug events, treatment, suicide means, or miscellaneous). To reduce the manual annotation effort, we preliminarily selected sentences with a pretrained zero-shot classifier or sentences containing only drug and suicide keywords. We trained a relation classification model using various Bidirectional Encoder Representations from Transformer embeddings with the proposed corpus. We then compared the performances of the model with different Bidirectional Encoder Representations from Transformer-based embeddings and selected the most suitable embedding for our corpus. RESULTS Our corpus comprised 11,894 sentences extracted from the titles and abstracts of the PubMed research articles. Each sentence was annotated with drug and suicide entities and the relationship between these 2 entities (adverse drug events, treatment, means, and miscellaneous). All of the tested relation classification models that were fine-tuned on the corpus accurately detected sentences of suicidal adverse events regardless of their pretrained type and data set properties. CONCLUSIONS To our knowledge, this is the first and most extensive corpus of drug-suicide relations.
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Affiliation(s)
- Karina Karapetian
- School of Computer Science and Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Soo Min Jeon
- College of Pharmacy, Jeju National University, Jeju, Republic of Korea
| | - Jin-Won Kwon
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Republic of Korea
| | - Young-Kyoon Suh
- School of Computer Science and Engineering, Kyungpook National University, Daegu, Republic of Korea
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Jansen K, Holling H. Random-effects meta-analysis models for the odds ratio in the case of rare events under different data-generating models: A simulation study. Biom J 2023; 65:e2200132. [PMID: 36216590 DOI: 10.1002/bimj.202200132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/19/2022] [Accepted: 08/25/2022] [Indexed: 11/06/2022]
Abstract
Meta-analysis of binary data is challenging when the event under investigation is rare, and standard models for random-effects meta-analysis perform poorly in such settings. In this simulation study, we investigate the performance of different random-effects meta-analysis models in terms of point and interval estimation of the pooled log odds ratio in rare events meta-analysis. First and foremost, we evaluate the performance of a hypergeometric-normal model from the family of generalized linear mixed models (GLMMs), which has been recommended, but has not yet been thoroughly investigated for rare events meta-analysis. Performance of this model is compared to performance of the beta-binomial model, which yielded favorable results in previous simulation studies, and to the performance of models that are frequently used in rare events meta-analysis, such as the inverse variance model and the Mantel-Haenszel method. In addition to considering a large number of simulation parameters inspired by real-world data settings, we study the comparative performance of the meta-analytic models under two different data-generating models (DGMs) that have been used in past simulation studies. The results of this study show that the hypergeometric-normal GLMM is useful for meta-analysis of rare events when moderate to large heterogeneity is present. In addition, our study reveals important insights with regard to the performance of the beta-binomial model under different DGMs from the binomial-normal family. In particular, we demonstrate that although misalignment of the beta-binomial model with the DGM affects its performance, it shows more robustness to the DGM than its competitors.
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Affiliation(s)
- Katrin Jansen
- University of Münster, Department of Psychology, Münster, Germany
| | - Heinz Holling
- University of Münster, Department of Psychology, Münster, Germany
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9
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Mocanu V, Wood E. Alcohol use disorder with comorbid anxiety disorder: a case report and focused literature review. Addict Sci Clin Pract 2022; 17:62. [DOI: 10.1186/s13722-022-00344-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
Alcohol use disorder (AUD) and anxiety disorders (AnxD) are prevalent health concerns in clinical practice which frequently co-occur (AUD-AnxD) and compound one another. Concurrent AUD-AnxD poses a challenge for clinical management as approaches to treatment of one disorder may be ineffective or potentially counterproductive for the other disorder.
Case Presentation
We present the case of a middle-aged man with anxiety disorder, AUD, chronic pain, and gamma-hydroxybutyrate use in context of tapering prescribed benzodiazepines who experienced severe alcohol withdrawal episodes during a complicated course of repeated inpatient withdrawal management. After medical stabilization, the patient found significant improvement in symptoms and no return to alcohol use with a regimen of naltrexone targeting his AUD, gabapentin targeting both his AUD and AnxD, and engagement with integrated psychotherapy, Alcoholics Anonymous, and addictions medicine follow-up.
Conclusion
Proper recognition and interventions for AUD and AnxD, ideally with overlapping efficacy, can benefit individuals with comorbid AUD-AnxD. Gabapentin, tobacco cessation, and integrated psychotherapy have preliminary evidence of synergistic effects in AUD-AnxD. Meta-analysis evidence does not support serotoninergic medications (e.g. selective serotonin reuptake inhibitors) which are commonly prescribed in AnxD and mood disorders as their use has not been associated with improved outcomes for AUD-AnxD. Additionally, several double-blind placebo-controlled randomized trials have suggested that serotonergic medications may worsen alcohol-related outcomes in some individuals with AUD. Areas for future investigation are highlighted.
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10
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Gobarani RK, Ilomäki J, Wood S, Abramson MJ, Bonevski B, George J. Characterising the use of varenicline: an analysis of the Australian dispensing claims data. Addiction 2022; 117:2683-2694. [PMID: 35603915 PMCID: PMC9542363 DOI: 10.1111/add.15949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS In Australia, patterns of use of smoking cessation medications and factors associated with their dispensing are currently not known. This study aimed to measure the demographic and clinical factors associated with varenicline dispensing compared with nicotine replacement therapy (NRT) and bupropion among first-time users of Pharmaceutical Benefits Scheme (PBS) subsidised smoking cessation medicines in Australia and to characterise those who discontinued varenicline treatment prematurely. DESIGN Retrospective, population-based study. Logistic regression was used to identify factors associated with varenicline dispensing compared with NRT and bupropion. Sensitivity analyses estimated the proportion of individuals who completed the recommended 12 weeks of varenicline treatment. SETTING AND PARTICIPANTS First-time users of PBS subsidised smoking cessation medicines in Australia. Individuals first dispensed a smoking cessation medicine between 2011 and 2019 were identified from a 10% random sample of the national dispensing claims data. MEASUREMENTS The outcome for the regression analysis was the dispensing of varenicline compared with NRT and bupropion. The dispensing of a smoking cessation medicine was identified using the World Health Organization Anatomical Therapeutic Chemical Classification System and PBS item codes. Independent variables included demographic and clinical characteristics such as sex, age, concessional status, year of treatment initiation and comorbidities identified using the Rx-Risk index. The proportion of people who discontinued varenicline treatment after the initiation pack was determined using prescription refill data. FINDINGS A total of 94 532 people had their first PBS subsidised smoking cessation medicine. Of these, 62 367 (66.0%) were dispensed varenicline, 29 949 (31.7%) NRT and 2216 (2.3%) bupropion. The odds of varenicline dispensing were higher in males (OR, 1.18; 95% CI, 1.14-1.21), but lower in older adults (0.86 [0.82-0.90] in above 30 years to 0.49 [0.47-0.52] in 61 years and above), among concession beneficiaries (0.44; 0.43-0.46), and those with congestive heart failure (0.60; 0.53-0.68), depression (0.61; 0.54-0.69), anxiety (0.70; 0.66-0.73), psychotic illness (0.39; 0.37-0.42), and chronic obstructive pulmonary disease (0.87; 0.82-0.92). The majority (37 670; 60.4%) of those dispensed varenicline discontinued treatment after the initiation pack. Anxiety and psychotic illnesses were significantly more prevalent in those who discontinued treatment. Only 2804 (4.5%) of those dispensed varenicline completed 12 weeks of treatment. CONCLUSION Individuals dispensed varenicline in Australia appear to be healthier compared with those who are dispensed nicotine replacement therapy or bupropion.
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Affiliation(s)
- Rukshar K. Gobarani
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityVictoriaAustralia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityVictoriaAustralia,School of Public Health and Preventive MedicineMonash UniversityVictoriaAustralia
| | - Stephen Wood
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityVictoriaAustralia
| | - Michael J. Abramson
- School of Public Health and Preventive MedicineMonash UniversityVictoriaAustralia
| | - Billie Bonevski
- Discipline Lead and Discipline Group Lead, College of Medicine and Public HealthFlinders UniversityAdelaideAustralia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityVictoriaAustralia,School of Public Health and Preventive MedicineMonash UniversityVictoriaAustralia
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11
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Does Smoking Affect OSA? What about Smoking Cessation? J Clin Med 2022; 11:jcm11175164. [PMID: 36079094 PMCID: PMC9457519 DOI: 10.3390/jcm11175164] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/23/2022] Open
Abstract
The connection between smoking and Obstructive sleep apnea (OSA) is not yet clear. There are studies that have confirmed the effect of smoking on sleep disordered breathing, whereas others did not. Nicotine affects sleep, as smokers have prolonged total sleep and REM latency, reduced sleep efficiency, total sleep time, and slow wave sleep. Smoking cessation has been related with impaired sleep. The health consequences of cigarette smoking are well documented, but the effect of smoking cessation on OSA has not been extensively studied. Smoking cessation should improve OSA as upper airway oedema may reduce, but there is limited data to support this hypothesis. The impact of smoking cessation pharmacotherapy on OSA has been studied, especially for nicotine replacement therapy (NRT). However, there are limited data on other smoking cessation medications as bupropion, varenicline, nortriptyline, clonidine, and cytisine. The aim of this review was to explore the current evidence on the association between smoking and OSA, to evaluate if smoking cessation affects OSA, and to investigate the possible effects of different pharmacologic strategies offered for smoking cessation on OSA.
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12
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Mills J. Varenicline (Chantix): The Smoking Cessation Medication Prescribers May Be Avoiding. Issues Ment Health Nurs 2022; 43:489-494. [PMID: 35412411 DOI: 10.1080/01612840.2022.2061806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jeremy Mills
- Peninsula, A Division of Parkwest Medical Center, Knoxville, Tennessee, USA
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13
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Dual Orexin Receptor Antagonists (DORAs) as an Adjunct Treatment for Smoking Cessation. CNS Drugs 2022; 36:411-417. [PMID: 35451800 DOI: 10.1007/s40263-022-00918-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 12/27/2022]
Abstract
Smoking is recognized as the most avoidable cause for multiplicity of chronic diseases. However, smoking cessation rates remain low, in part due to the limited target engagement of the currently approved medications for smoking cessation. Sleep is a promising focus for increasing smoking cessation rates because smokers' sleep problems are exacerbated during the first week of smoking abstinence and are associated with poor smoking cessation outcomes. Furthermore, the currently approved smoking cessation pharmacological agents varenicline and nicotine replacement treatment exacerbate sleep problems beyond what would be observed as a consequence of natural nicotine withdrawal. Addressing sleep problems with dual orexin receptor antagonists (DORAs) is positioned to remedy the shortcoming of overlooking sleep as a viable smoking cessation intervention target. Based on previous animal literature, DORA agents suvorexant and lemborexant may accomplish this by diminishing withdrawal difficulty and reducing nicotine cravings. The pharmacologic focus is the orexin system, not only because orexin peptides mediate the sleep-wake cycle, but also because DORA agents have a milder adverse event profile over previous treatments for insomnia. A novel adjunct DORA treatment to a currently approved smoking cessation pharmacotherapy holds a potential to reduce morbidity and mortality caused by smoking.
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14
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Thomas KH, Dalili MN, López‐López JA, Keeney E, Phillippo DM, Munafò MR, Stevenson M, Caldwell DM, Welton NJ. Comparative clinical effectiveness and safety of tobacco cessation pharmacotherapies and electronic cigarettes: a systematic review and network meta-analysis of randomized controlled trials. Addiction 2022; 117:861-876. [PMID: 34636108 PMCID: PMC9293179 DOI: 10.1111/add.15675] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 08/11/2021] [Indexed: 12/27/2022]
Abstract
AIM To determine how varenicline, bupropion, nicotine replacement therapy (NRT) and electronic cigarettes compare with respect to their clinical effectiveness and safety. METHOD Systematic reviews and Bayesian network meta-analyses of randomized controlled trials, in any setting, of varenicline, bupropion, NRT and e-cigarettes (in high, standard and low doses, alone or in combination) in adult smokers and smokeless tobacco users with follow-up duration of 24 weeks or greater (effectiveness) or any duration (safety). Nine databases were searched until 19 February 2019. Primary outcomes were sustained tobacco abstinence and serious adverse events (SAEs). We estimated odds ratios (ORs) and treatment rankings and conducted meta-regression to explore covariates. RESULTS We identified 363 trials for effectiveness and 355 for safety. Most monotherapies and combination therapies were more effective than placebo at helping participants to achieve sustained abstinence; the most effective of these, estimated with some imprecision, were varenicline standard [OR = 2.83, 95% credible interval (CrI) = 2.34-3.39] and varenicline standard + NRT standard (OR = 5.75, 95% CrI = 2.27-14.88). Estimates were higher in smokers receiving counselling than in those without and in studies with higher baseline nicotine dependence scores than in those with lower scores. Varenicline standard + NRT standard showed a high probability of being ranked best or second-best. For safety, only bupropion at standard dose increased the odds of experiencing SAEs compared with placebo (OR = 1.27, 95% CrI = 1.04-1.58), and we found no evidence of effect modification. CONCLUSIONS Most tobacco cessation monotherapies and combination therapies are more effective than placebo at helping participants to achieve sustained abstinence, with varenicline appearing to be most effective based on current evidence. There does not appear to be strong evidence of associations between most tobacco cessation pharmacotherapies and adverse events; however, the data are limited and there is a need for improved reporting of safety data.
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Affiliation(s)
- Kyla H. Thomas
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
| | - Michael N. Dalili
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
| | - José A. López‐López
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK,Department of Basic Psychology and Methodology, Faculty of PsychologyUniversity of MurciaMurciaSpain
| | - Edna Keeney
- Statistical and Health Economic Modelling, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - David M. Phillippo
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
| | - Marcus R. Munafò
- School of Psychological ScienceUniversity of BristolBristolUK,MRC Integrative Epidemiology Unit at the University of BristolBristolUK
| | - Matt Stevenson
- Health Economics and Decision Science, School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | | | - Nicky J. Welton
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
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15
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Nall RW, Beloate LN, Meyerink ME, Penaloza T, Doolittle J, Froeliger B, Kalivas PW, Garcia-Keller C. Assessing combined effects of varenicline and N-acetylcysteine on reducing nicotine seeking in rats. Addict Biol 2022; 27:e13151. [PMID: 35229943 PMCID: PMC10777539 DOI: 10.1111/adb.13151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 12/22/2021] [Accepted: 01/14/2022] [Indexed: 11/27/2022]
Abstract
Nicotine addiction is a chronic relapsing brain disorder, and cigarette smoking is the leading cause of preventable death in the United States. Currently, the most effective pharmacotherapy for smoking cessation is Varenicline (VRN), which reduces both positive and negative reinforcement by nicotine. Clinically, VRN attenuates withdrawal symptoms and promotes abstinence, but >50% of smokers relapse within 3 months following a quit attempt. This may indicate that VRN fails to ameliorate components of nicotine-induced neuroplasticity that promote relapse vulnerability. Animal models reveal that glutamate dysregulation in the nucleus accumbens is associated with nicotine relapse. N-acetylcysteine (NAC) normalizes glutamate transmission and prolongs cocaine abstinence. Thus, combining VRN and NAC may promote and maintain, respectively, nicotine abstinence. In rats, we found that VRN effectively reduced nicotine self-administration and seeking in early abstinence, but not seeking later in abstinence. In contrast, NAC reduced seeking only later in abstinence. Because VRN and NAC are sometimes associated with mild adverse effects, we also evaluated a sequential approach combining subthreshold doses of VRN during self-administration and early abstinence with subthreshold doses of NAC during late abstinence. As expected, subthreshold VRN did not reduce nicotine intake. However, subthreshold VRN and NAC reduced seeking in late abstinence, suggesting a combined effect. Overall, our results suggest that combining subthreshold VRN and NAC is a viable and drug-specific approach to promote abstinence and reduce relapse while minimizing adverse effects. Our data also suggest that different components and time points in addiction engage the different neurocircuits targeted by VRN and NAC.
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Affiliation(s)
- Rusty W. Nall
- Department of Neuroscience, Medical University of South Carolina, 173 Ashley Ave, Charleston, SC 29425
- Department of Psychology, Jacksonville State University, 700 Pelham Rd. N., Jacksonville, AL, 36265
| | - Lauren N. Beloate
- Department of Neuroscience, Medical University of South Carolina, 173 Ashley Ave, Charleston, SC 29425
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA 16802
| | - Michael E. Meyerink
- Department of Neuroscience, Medical University of South Carolina, 173 Ashley Ave, Charleston, SC 29425
| | - Tiffany Penaloza
- Department of Neuroscience, Medical University of South Carolina, 173 Ashley Ave, Charleston, SC 29425
| | - Jade Doolittle
- Department of Neuroscience, Medical University of South Carolina, 173 Ashley Ave, Charleston, SC 29425
| | - Brett Froeliger
- Department of Neuroscience, Medical University of South Carolina, 173 Ashley Ave, Charleston, SC 29425
- Department of Psychiatry, Department of Psychological Sciences, University of Missouri-Columbia, 1 Hospital Dr, Columbia, MO 65201
| | - Peter W. Kalivas
- Department of Neuroscience, Medical University of South Carolina, 173 Ashley Ave, Charleston, SC 29425
| | - Constanza Garcia-Keller
- Department of Neuroscience, Medical University of South Carolina, 173 Ashley Ave, Charleston, SC 29425
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16
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Soreca I, Conklin CA, Vella EJ, Salkeld RP, Joyce CJ, Mumma JM, Jakicic JM, Kupfer DJ. Can exercise alleviate sleep disturbances during acute nicotine withdrawal in cigarette smokers? Exp Clin Psychopharmacol 2022; 30:82-92. [PMID: 33119386 PMCID: PMC8415013 DOI: 10.1037/pha0000390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Sleep disturbances, including insomnia (difficulty falling or staying asleep), are common nicotine withdrawal symptoms particularly during the initial stage of nicotine abstinence, and increase the likelihood of relapse within the first 4 weeks of quitting. Although clinically recognized as a key symptom of nicotine withdrawal, sleep disturbances are not addressed in the clinical guidelines for nicotine dependence treatment. Unfortunately, Nicotine Replacement Therapy (NRT) and other pharmacologic interventions do not attenuate withdrawal-provoked sleep disturbances, with several even exacerbating sleep disruption. The present study tested the impact of 30-min of daily moderate exercise, morning versus evening, on key polysomnographic indicators of sleep disturbances during initial 3 days (72 hr) of nicotine withdrawal. Forty-nine daily smokers (53% male) completed 3 separate abstinence periods, during which they completed either morning exercise, evening exercise, or a nonexercising magazine reading control condition. Order of condition was counterbalanced across subjects with a 1-week wash out in between each 3-day abstinence period. Exercise engagement mitigated several changes in sleep architecture associated with acute nicotine deprivation and other time-related effects on sleep, specifically frequency of arousals (B = -2.8, SE = .95; t(1271) = -3.0, p = .003) and reductions in sleep maintenance (B = .58, SE = .21; t(1270) = 2.8, p = .005). Additionally, smokers who reported greater perceived withdrawal severity had the longest latency to fall asleep but experienced the greatest attenuation of this effect following PM exercise. Overall, results suggest a role for exercise as an adjunct smoking cessation treatment to specifically target sleep disturbances during early acute nicotine withdrawal. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Isabella Soreca
- Pittsburgh Veterans Administration Healthcare System, Pittsburgh PA
| | | | | | | | | | - Joel M. Mumma
- University of Pittsburgh, Department of Psychiatry, Pittsburgh PA
| | - John M. Jakicic
- University of Pittsburgh, Department of Health and Physical Activity, Pittsburgh PA
| | - David J. Kupfer
- University of Pittsburgh, Department of Psychiatry, Pittsburgh PA
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17
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Ock M, Shin JS, Ra SW. Safety and Effectiveness of Varenicline in Korean Smokers: A Nationwide Post-Marketing Surveillance Study. Patient Prefer Adherence 2022; 16:413-426. [PMID: 35210758 PMCID: PMC8858022 DOI: 10.2147/ppa.s344757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/20/2022] [Indexed: 12/04/2022] Open
Abstract
PURPOSE Varenicline has demonstrated its safety and efficacy in Western studies including <3% of Asian participants. This prospective multi-center observational study investigated the safety and effectiveness of varenicline in Korean smokers. PATIENTS AND METHODS Smokers prescribed varenicline for the first time were enrolled from 252 medical institutions. Investigators recorded and graded all adverse events (AEs). To assess the effectiveness of varenicline, the 7-day point prevalence (PP) of smoking cessation was evaluated at the four visits during the 12-week treatment course. Rates of AE incidence and smoking cessation were analyzed using Chi-squared test or Fisher's exact test. This study is registered with ClinicalTrials.gov, number NCT00483002. RESULTS A total of 3719 and 3700 study subjects were included in the safety and effectiveness analyses, respectively. Overall, 346 (9.3%) subjects experienced 471 AEs: 358 mild, 97 moderate, 9 severe, and 7 serious. The most frequent AEs were nausea (5.1%), dyspepsia (0.8%), abnormal dreams (0.8%), insomnia (0.8%), and headache (0.7%). Among the subjects with AEs, 73 subjects discontinued treatment, of which 68 were due to AE occurrence. The 7-day PP of smoking cessation at weeks 1-2, 3-6, 7-10, and ≥ week 11 were 51.7% (387/749), 59.6% (1740/2922), 73.3% (1114/1520), and 77.0% (1116/1449), respectively (p for trend = 0.023). Comorbidities and allergies were associated with a higher incidence of AEs and lower smoking cessation rate (p < 0.05). Younger subjects, infrequent alcohol drinkers, and lighter smokers showed a higher smoking cessation rate (p < 0.05). CONCLUSION Varenicline in adult Korean smokers was well tolerated and effective as a smoking cessation aid in routine clinical practice.
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Affiliation(s)
- Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Ji Soo Shin
- Medical Affairs, Pfizer Korea, Seoul, South Korea
| | - Seung Won Ra
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
- Correspondence: Seung Won Ra, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea, Tel +82 52 250 8857, Fax +82 52 250 7048, Email
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18
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Falcaro M, Osborn D, Hayes J, Coyle G, Couperthwaite L, Weich S, Walters KR. Time trends in access to smoking cessation support for people with depression or severe mental illness: a cohort study in English primary care. BMJ Open 2021; 11:e048341. [PMID: 34862277 PMCID: PMC8647398 DOI: 10.1136/bmjopen-2020-048341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 11/05/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To investigate delivery of smoking cessation interventions, recorded quit attempts and successful quitting rates within primary care in smokers with depression or severe mental illness (SMI) compared with those without. DESIGN Longitudinal cohort study using primary healthcare records. SETTING English primary care. PARTICIPANTS 882 849 patients registered with participating practices recorded as current smokers during 2007-2014, including three groups: (1) 13 078 with SMI, (2) 55 630 with no SMI but recent depression and (3) 814 141 with no SMI nor recent depression. OUTCOMES Recorded advice to quit smoking, referrals to smoking cessation services, prescriptions for smoking cessation medication, recorded quit attempts and changes of smoking status. RESULTS The majority (>70%) of smokers had recorded smoking cessation advice. This was consistently higher in those with SMI than the other cohorts of patients, although the gap greatly reduced in more recent years. Increases in smoking cessation advice over time were not accompanied by increases in recorded attempts to quit or changes of smoking status. Overall nicotine replacement therapy prescribing by general practitioners (GPs) was higher in those with SMI (10.1%) and depression (8.7%) than those without (5.9%), but a downward time trend was observed in all groups. Bupropion and varenicline prescribing was very low and lower for those with SMI. Few smokers (<5%) had referrals to stop smoking services, though this increased over time, but no significant differences were observed between those with and without mental health problems. CONCLUSIONS There was no evidence of consistent inequalities in access to GP-delivered smoking cessation interventions for people with mental health conditions. Smoking cessation advice was widely reported as taking place in all groups. In order to address the widening gap in smoking prevalence in those with poor mental health compared with those without, the emphasis should be on addressing the quality of advice and support given.
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Affiliation(s)
| | - David Osborn
- Faculty of Brain Sciences, University College London, London, UK
| | - Joseph Hayes
- Faculty of Brain Sciences, University College London, London, UK
| | | | | | - Scott Weich
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Kate R Walters
- Department of Primary Care & Population Health, University College London, London, UK
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Devresse A, Gohy S, Robert A, Kanaan N. How to manage cigarette smoking in kidney transplant candidates and recipients? Clin Kidney J 2021; 14:2295-2303. [PMID: 34754426 PMCID: PMC8572985 DOI: 10.1093/ckj/sfab072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/19/2021] [Indexed: 01/15/2023] Open
Abstract
Tobacco smoking is a frequent problem affecting many kidney transplant (KT) candidates and recipients. The negative impact of active smoking on KT outcomes has been demonstrated. Consequently, most guidelines strongly recommend quitting smoking before considering kidney transplantation. However, nicotine addiction is a complex multifactorial disease and only 3–5% of the patients who try to quit by themselves achieve prolonged abstinence. Smoking cessation programmes (SCPs) have proven their efficacy in the general population to increase the rate of quitting and should therefore be proposed to all smoking KT candidates and recipients. Nevertheless, SCPs have not been evaluated in the KT field and not all KT centres have easy access to these programmes. In this work, we aim to review the current knowledge on the subject and provide an overview of the available interventions to help smoking patients quit. We detail non-pharmaceutical and pharmaceutical approaches and discuss their use in KT candidates and recipients.
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Affiliation(s)
- Arnaud Devresse
- Nephrology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Sophie Gohy
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Arnaud Robert
- Nephrology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Nada Kanaan
- Nephrology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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20
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Thomas KH, Dalili MN, López-López JA, Keeney E, Phillippo D, Munafò MR, Stevenson M, Caldwell DM, Welton NJ. Smoking cessation medicines and e-cigarettes: a systematic review, network meta-analysis and cost-effectiveness analysis. Health Technol Assess 2021; 25:1-224. [PMID: 34668482 DOI: 10.3310/hta25590] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cigarette smoking is one of the leading causes of early death. Varenicline [Champix (UK), Pfizer Europe MA EEIG, Brussels, Belgium; or Chantix (USA), Pfizer Inc., Mission, KS, USA], bupropion (Zyban; GlaxoSmithKline, Brentford, UK) and nicotine replacement therapy are licensed aids for quitting smoking in the UK. Although not licensed, e-cigarettes may also be used in English smoking cessation services. Concerns have been raised about the safety of these medicines and e-cigarettes. OBJECTIVES To determine the clinical effectiveness, safety and cost-effectiveness of smoking cessation medicines and e-cigarettes. DESIGN Systematic reviews, network meta-analyses and cost-effectiveness analysis informed by the network meta-analysis results. SETTING Primary care practices, hospitals, clinics, universities, workplaces, nursing or residential homes. PARTICIPANTS Smokers aged ≥ 18 years of all ethnicities using UK-licensed smoking cessation therapies and/or e-cigarettes. INTERVENTIONS Varenicline, bupropion and nicotine replacement therapy as monotherapies and in combination treatments at standard, low or high dose, combination nicotine replacement therapy and e-cigarette monotherapies. MAIN OUTCOME MEASURES Effectiveness - continuous or sustained abstinence. Safety - serious adverse events, major adverse cardiovascular events and major adverse neuropsychiatric events. DATA SOURCES Ten databases, reference lists of relevant research articles and previous reviews. Searches were performed from inception until 16 March 2017 and updated on 19 February 2019. REVIEW METHODS Three reviewers screened the search results. Data were extracted and risk of bias was assessed by one reviewer and checked by the other reviewers. Network meta-analyses were conducted for effectiveness and safety outcomes. Cost-effectiveness was evaluated using an amended version of the Benefits of Smoking Cessation on Outcomes model. RESULTS Most monotherapies and combination treatments were more effective than placebo at achieving sustained abstinence. Varenicline standard plus nicotine replacement therapy standard (odds ratio 5.75, 95% credible interval 2.27 to 14.90) was ranked first for sustained abstinence, followed by e-cigarette low (odds ratio 3.22, 95% credible interval 0.97 to 12.60), although these estimates have high uncertainty. We found effect modification for counselling and dependence, with a higher proportion of smokers who received counselling achieving sustained abstinence than those who did not receive counselling, and higher odds of sustained abstinence among participants with higher average dependence scores. We found that bupropion standard increased odds of serious adverse events compared with placebo (odds ratio 1.27, 95% credible interval 1.04 to 1.58). There were no differences between interventions in terms of major adverse cardiovascular events. There was evidence of increased odds of major adverse neuropsychiatric events for smokers randomised to varenicline standard compared with those randomised to bupropion standard (odds ratio 1.43, 95% credible interval 1.02 to 2.09). There was a high level of uncertainty about the most cost-effective intervention, although all were cost-effective compared with nicotine replacement therapy low at the £20,000 per quality-adjusted life-year threshold. E-cigarette low appeared to be most cost-effective in the base case, followed by varenicline standard plus nicotine replacement therapy standard. When the impact of major adverse neuropsychiatric events was excluded, varenicline standard plus nicotine replacement therapy standard was most cost-effective, followed by varenicline low plus nicotine replacement therapy standard. When limited to licensed interventions in the UK, nicotine replacement therapy standard was most cost-effective, followed by varenicline standard. LIMITATIONS Comparisons between active interventions were informed almost exclusively by indirect evidence. Findings were imprecise because of the small numbers of adverse events identified. CONCLUSIONS Combined therapies of medicines are among the most clinically effective, safe and cost-effective treatment options for smokers. Although the combined therapy of nicotine replacement therapy and varenicline at standard doses was the most effective treatment, this is currently unlicensed for use in the UK. FUTURE WORK Researchers should examine the use of these treatments alongside counselling and continue investigating the long-term effectiveness and safety of e-cigarettes for smoking cessation compared with active interventions such as nicotine replacement therapy. STUDY REGISTRATION This study is registered as PROSPERO CRD42016041302. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 59. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kyla H Thomas
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael N Dalili
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - José A López-López
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Edna Keeney
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Phillippo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Marcus R Munafò
- Faculty of Life Sciences, School of Psychological Science, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,UK Centre for Tobacco and Alcohol Studies, University of Bristol, Bristol, UK
| | - Matt Stevenson
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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21
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Varenicline administration for smoking cessation may reduce apnea hypopnea index in sleep apnea patients. Sleep Med 2021; 88:87-89. [PMID: 34740170 DOI: 10.1016/j.sleep.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/03/2021] [Accepted: 10/05/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE/BACKGROUND Varenicline (VAR) is used for smoking cessation as it inhibits nicotine for binding on its receptors reducing nicotine dependence. VAR administration has been reported to affect sleep. The aim of this study was to evaluate possible changes in polysomnography (PSG) during VAR treatment (SmokeFreeBrain) in healthy smokers and smokers with obstructive sleep apnea (OSA). PATIENTS/METHODS Thirty smokers (21 men) with 15.3 ± 10.2 PY, aged 32.8 ± 4.5 years, with BMI 28.6 ± 4 kg/m2, 16 without and 14 with OSA (92% males) were studied with PSG (Embletta MPR-Master) before treatment with VAR while smoking and 20-30 days during VAR administration and smoking cessation for at least 5 days. RESULTS No significant differences were observed in sleep macro architecture (N1, N2, N3, REM, Sleep Efficiency, Total Sleep Time) during VAR treatment apart from prolongation of sleep latency, N2 and N3 latency in both smokers with and without OSA. Apnea hypopnea index (AHI) was reduced in OSA smokers and especially during REM with a borderline increase of arousal index (ArI) and reduction of sleep efficiency (SE). CONCLUSION VAR treatment worsened sleep quality as a prolongation of sleep latency, N2 and N3 latency was observed. A marginal reduction of AHI was found in OSA patients, more significantly during REM. Due to the small sample size, further studies are needed to distinguish between the adverse reactions of VAR treatment and smoking cessation effects and to evaluate whether VAR may play a role in OSA treatment.
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22
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Beard E, Jackson SE, Anthenelli RM, Benowitz NL, Aubin LS, McRae T, Lawrence D, Russ C, Krishen A, Evins AE, West R. Estimation of risk of neuropsychiatric adverse events from varenicline, bupropion and nicotine patch versus placebo: secondary analysis of results from the EAGLES trial using Bayes factors. Addiction 2021; 116:2816-2824. [PMID: 33885203 PMCID: PMC8612131 DOI: 10.1111/add.15440] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/14/2020] [Accepted: 01/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Analysed using classical frequentist hypothesis testing with alpha set to 0.05, the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) did not find enough evidence to reject the hypothesis of no difference in neuropsychiatric adverse events (NPSAEs) attributable to varenicline, bupropion, or nicotine patch compared with placebo. This might be because the null hypothesis was true or because the data were insensitive. The present study aimed to test the hypothesis more directly using Bayes factors. DESIGN EAGLES was a randomised, double-blind, triple-dummy, controlled trial. SETTING Global (16 countries across five continents), between November 2011 and January 2015. PARTICIPANTS Participants were smokers with (n = 4116) and without (n = 4028) psychiatric disorders. INTERVENTIONS Varenicline (1 mg twice daily), bupropion (150 mg twice daily), nicotine patch (21 mg once daily with taper) and matched placebos. MEASUREMENTS The outcomes included: (i) a composite measure of moderate/severe NPSAEs; and (ii) a composite measure of severe NPSAEs. The relative evidence for there being no difference in NPSAEs versus data insensitivity for the medications was calculated in the full and sub-samples using Bayes factors and corresponding robustness regions. FINDINGS For all but two comparisons, Bayes factors were <1/3, indicating moderate to strong evidence for no difference in risk of NPSAEs between active medications and placebo (Bayes factor = 0.02-0.23). In the psychiatric cohort versus placebo, the data were suggestive, but not conclusive of no increase in NPSAEs with varenicline (Bayes factor = 0.52) and bupropion (Bayes factor = 0.71). Here, the robustness regions ruled out a ≥7% and ≥8% risk increase with varenicline and bupropion, respectively. CONCLUSIONS Secondary analysis of the Evaluating Adverse Events in a Global Smoking Cessation Study trial using Bayes factors provides moderate to strong evidence that use of varenicline, bupropion or nicotine patches for smoking cessation does not increase the risk of neuropsychiatric adverse events relative to use of placebo in smokers without a history of psychiatric disorder. For smokers with a history of psychiatric disorder the evidence also points to no increased risk but with less confidence.
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Affiliation(s)
- Emma Beard
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Sarah E. Jackson
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | | | | | | | | | | | | | | | - A. Eden Evins
- Massachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
| | - Robert West
- Research Department of Behavioural Science and HealthUniversity College LondonLondonUK
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23
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Wang Y, van Boven JFM, Bos JHJ, Schuiling-Veninga CCM, Boezen HM, Wilffert B, Hak E. Risk of neuropsychiatric adverse events associated with varenicline treatment for smoking cessation among Dutch population: A sequence symmetry analysis. Pharmacoepidemiol Drug Saf 2021; 31:158-166. [PMID: 34464494 PMCID: PMC9292305 DOI: 10.1002/pds.5351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 12/02/2022]
Abstract
Purpose Varenicline is an effective treatment for smoking cessation. While clinical trials did not confirm a causal role, case reports suggested a possible link of varenicline with neuropsychiatric adverse drug events (NPAEs). This study aims to investigate the risk of NPAEs associated with varenicline initiation among the general population in a real‐world setting. Methods We conducted a sequence symmetry analysis (SSA) based on the University of Groningen IADB.nl prescription database. We selected incident users of both varenicline and marker drugs for NPAEs, including depression, anxiety and sleep disorder within different time‐intervals. Adjusted sequence ratios (aSR) were calculated for each time‐interval. Results Within 365‐days' time‐interval 1066 patients were incident users of both varenicline and NPAE marker drugs. In total, 505 patients were prescribed varenicline before NPAE marker drugs and 561 vice versa (crude sequence ratio [cSR] 0.90, 95% CI: 0.80–1.02). After adjustments for trends in prescriptions, overall a null association was found (aSR 1.00, 95% CI: 0.89–1.13). Regarding specific NPAEs, no increased risks were found for depression nor anxiety within any time‐interval. A small transient increased risk was found for sleep disorders, particularly in earlier time‐intervals 3 and 6 months (aSRs 1.52, 95% CI: 1.10–2.11 and 1.45, 95% CI: 1.15–1.83, respectively). Subgroup and sensitivity analyses showed similar findings. Conclusions Varenicline initiation was unlikely to be associated with an increased risk of taking anti‐depressants nor anti‐anxiety drugs. Yet a small, but statistically significant, transient association with drugs for sleep disorders was noticed, possibly associated with withdrawal symptoms caused by smoking cessation.
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Affiliation(s)
- Yuanyuan Wang
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Job F M van Boven
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jens H J Bos
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Catharina C M Schuiling-Veninga
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - H Marike Boezen
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bob Wilffert
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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24
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Katzenberg G, Deacon A, Aigbirior J, Vestbo J. Management of chronic obstructive pulmonary disease. Br J Hosp Med (Lond) 2021; 82:1-10. [PMID: 34338012 DOI: 10.12968/hmed.2020.0561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic obstructive pulmonary disease is a prevalent condition in the UK, associated with high morbidity and mortality. Hospital physicians manage a significant portion of acute chronic obstructive pulmonary disease admissions to hospital and readmissions after discharge. Optimal management of exacerbations requires controlled oxygen therapy and ventilatory support where necessary, and careful administration of bronchodilators, steroids and antibiotics. Holistic care for these patients includes nutritional supplementation and palliative support for those with advanced disease. To reduce the chance of readmission, chronic obstructive pulmonary disease care bundles can be used, along with a review of inhaled and oral therapies. Where available, hospital-at-home discharge schemes can safely facilitate early discharge. Most importantly, high quality evidence-based smoking cessation support must be offered to smokers. Exercise improves the physiological and psychological condition of people with chronic obstructive pulmonary disease and should be encouraged, with referral to a pulmonary rehabilitation service if available.
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Affiliation(s)
- Gideon Katzenberg
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester Academic Science Centre, Manchester, UK
| | - Andrew Deacon
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester Academic Science Centre, Manchester, UK
| | - Joshua Aigbirior
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester Academic Science Centre, Manchester, UK
| | - Jørgen Vestbo
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester Academic Science Centre, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
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25
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Thomas KH, Davies NM, Taylor AE, Taylor GMJ, Gunnell D, Martin RM, Douglas I. Risk of neuropsychiatric and cardiovascular adverse events following treatment with varenicline and nicotine replacement therapy in the UK Clinical Practice Research Datalink: a case-cross-over study. Addiction 2021; 116:1532-1545. [PMID: 33197082 PMCID: PMC8246946 DOI: 10.1111/add.15338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/30/2019] [Accepted: 11/09/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS Varenicline and nicotine replacement therapy (NRT) are the most commonly used medications to quit smoking. Given their widespread use, monitoring adverse risks remains important. This study aimed to estimate the neuropsychiatric and cardiovascular risks associated with varenicline and NRT as used in routine UK care. DESIGN Case-cross-over study. SETTING UK-based electronic primary care records in the Clinical Practice Research Datalink from 2006 to 2015 linked to hospital and mortality data sets. PARTICIPANTS Adult smokers (n =282,429) observed during periods when exposed and not exposed to either varenicline or NRT. MEASUREMENTS Main outcomes included suicide, self-harm, myocardial infarction (MI), all-cause death and cause-specific death [MI, chronic obstructive pulmonary disease (COPD)]. In primary analyses, conditional logistic regression was used to compare the chance of varenicline or NRT exposure during the risk period (90 days prior to the event) with the chance of exposure during an earlier single reference period (91-180 days prior to the event) or multiple 90-day reference periods to increase statistical power. FINDINGS In the primary analyses, findings were inconclusive for the associations between varenicline and the main outcomes using a single reference period, while NRT was associated with MI [odds ratio (OR) = 1.40, 95% confidence interval (CI) = 1.18-1.67]. Using multiple reference periods, varenicline was associated with an increased risk of self-harm (OR = 1.32, 95% CI = 1.12-1.56) and suicide (OR = 3.56, 95% CI = 1.32-9.60) but a reduction in all-cause death (OR = 0.75, 95% CI = 0.61-0.93). NRT was associated with MI (OR = 1.54, 95% CI = 1.36-1.74), self-harm (OR = 1.30, 95% CI = 1.18-1.44) and deaths from MI (OR = 1.53, 95% CI = 1.11-2.10), COPD (OR = 1.33, 95% CI = 1.14-1.56) and all causes (OR = 1.28, 95% CI = 1.18-1.40) when using multiple reference periods. CONCLUSIONS There appear to be positive associations between (1) nicotine replacement therapy (NRT) and myocardial infarction, death and risk of self-harm and (2) varenicline and increased risk of self-harm and suicide, as well as a negative association between varenicline and all-cause death. The associations may not be causal. They may reflect health changes at the time of smoking cessation (nicotine replacement therapy is prescribed for people with cardiac problems) or be associated with quit attempts (exposure to both medicines was associated with self-harm).
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Affiliation(s)
- Kyla H. Thomas
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK
| | - Neil M. Davies
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK,Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK,K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNUNorwegian University of Science and TechnologyNorway
| | - Amy E. Taylor
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK,National Institute for Health Research, Bristol Biomedical Research CentreUniversity Hospitals Bristol NHS Foundation Trust and University of BristolBristolUK
| | - Gemma M. J. Taylor
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
| | - David Gunnell
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK,National Institute for Health Research, Bristol Biomedical Research CentreUniversity Hospitals Bristol NHS Foundation Trust and University of BristolBristolUK
| | - Richard M. Martin
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK,Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK,National Institute for Health Research, Bristol Biomedical Research CentreUniversity Hospitals Bristol NHS Foundation Trust and University of BristolBristolUK
| | - Ian Douglas
- Department of Non‐communicable Disease Epidemiology, Faculty of Epidemiology and Population HealthLSHTMLondonUK
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26
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Wang Y, Bos JH, Schuiling-Veninga CCM, Boezen HM, van Boven JFM, Wilffert B, Hak E. Neuropsychiatric safety of varenicline in the general and COPD population with and without psychiatric disorders: a retrospective cohort study in a real-world setting. BMJ Open 2021; 11:e042417. [PMID: 34035088 PMCID: PMC8154988 DOI: 10.1136/bmjopen-2020-042417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To evaluate the real-world association between varenicline and neuropsychiatric adverse events (NPAEs) in general and chronic obstructive pulmonary disease (COPD) population with and without psychiatric disorders compared with nicotine replacement therapy (NRT) to strengthen the knowledge of varenicline safety. DESIGN A retrospective cohort study. SETTING Prescription database IADB.nl, the Netherlands. PARTICIPANTS New users of varenicline or NRT among general (≥18 years) and COPD (≥40 years) population. Psychiatric subcohort was defined as people prescribed psychotropic medications (≥2) within 6 months before the index date. OUTCOME MEASURES The incidence of NPAEs including depression, anxiety and insomnia, defined by new or naive prescriptions of related medications in IADB.nl within 24 weeks after the first treatment initiation of varenicline or NRT. RESULTS For the general population in non-psychiatric cohort, the incidence of total NPAEs in varenicline (4480) and NRT (1970) groups was 10.5% and 12.6%, respectively (adjusted OR (aOR) 0.85, 95% CI 0.72 to 1.00). For the general population in psychiatric cohort, the incidence of total NPAEs was much higher, 75.3% and 78.5% for varenicline (1427) and NRT (1200) groups, respectively (aOR 0.82, 95% CI 0.68 to 0.99). For the COPD population (1598), there were no differences in the incidence of NPAEs between comparison groups in both the psychiatric cohort (aOR 0.97, 95% CI 0.66 to 1.44) and non-psychiatric cohort (aOR 0.81, 95% CI 0.54 to 1.20). Results from subgroup or sensitivity analyses also did not reveal increased risks of NPAEs but showed decreased risk of some subgroup NPAEs associated with varenicline. CONCLUSIONS In contrast to the concerns of a possible increased risk of NPAEs among varenicline users, we found a relative decreased risk of total NPAEs in varenicline users of the general population in psychiatric or non-psychiatric cohorts compared with NRT and no difference for NPAEs between varenicline and NRT users in smaller population with COPD.
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Affiliation(s)
- Yuanyuan Wang
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institutte of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Jens H Bos
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institutte of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Catharina C M Schuiling-Veninga
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institutte of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - H Marike Boezen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Job F M van Boven
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bob Wilffert
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institutte of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institutte of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Patnode CD, Henderson JT, Coppola EL, Melnikow J, Durbin S, Thomas RG. Interventions for Tobacco Cessation in Adults, Including Pregnant Persons: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 325:280-298. [PMID: 33464342 DOI: 10.1001/jama.2020.23541] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE It has been estimated that in 2018 nearly 20% of adults in the US were currently using a tobacco product. OBJECTIVE To systematically review the effectiveness and safety of pharmacotherapy, behavioral interventions, and electronic cigarettes for tobacco cessation among adults, including pregnant persons, to inform the US Preventive Services Task Force. DATA SOURCES PubMed, PsycInfo, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews, Centre for Reviews and Dissemination of Health Technology Assessment; surveillance through September 25, 2020. STUDY SELECTION Systematic reviews of tobacco cessation interventions and randomized clinical trials that evaluated the effects of electronic cigarettes (e-cigarettes) or pharmacotherapy among pregnant persons. DATA EXTRACTION AND SYNTHESIS Independent critical appraisal and data abstraction; qualitative synthesis and random-effects meta-analyses. MAIN OUTCOMES AND MEASURES Health outcomes, tobacco cessation at 6 months or more, and adverse events. RESULTS Sixty-seven reviews addressing pharmacotherapy and behavioral interventions were included as well as 9 trials (N = 3942) addressing e-cigarettes for smoking cessation and 7 trials (N = 2285) of nicotine replacement therapy (NRT) use in pregnancy. Combined pharmacotherapy and behavioral interventions (pooled risk ratio [RR], 1.83 [95% CI, 1.68-1.98]), NRT (RR, 1.55 [95% CI, 1.49-1.61]), bupropion (RR, 1.64 [95% CI, 1.52-1.77]), varenicline (RR, 2.24 [95% CI, 2.06-2.43]), and behavioral interventions such as advice from clinicians (RR, 1.76 [95% CI, 1.58-1.96]) were all associated with increased quit rates compared with minimal support or placebo at 6 months or longer. None of the drugs were associated with serious adverse events. Five trials (n = 3117) reported inconsistent findings on the effectiveness of electronic cigarettes on smoking cessation at 6 to 12 months among smokers when compared with placebo or NRT, and none suggested higher rates of serious adverse events. Among pregnant persons, behavioral interventions were associated with greater smoking cessation during late pregnancy (RR, 1.35 [95% CI, 1.23-1.48]), compared with no intervention. Rates of validated cessation among pregnant women allocated to NRT compared with placebo were not significantly different (pooled RR, 1.11 [95% CI, 0.79-1.56], n = 2033). CONCLUSIONS AND RELEVANCE There is strong evidence that a range of pharmacologic and behavioral interventions, both individually and in combination, are effective in increasing smoking cessation in nonpregnant adults. In pregnancy, behavioral interventions are effective for smoking cessation, but data are limited on the use of pharmacotherapy for smoking cessation. Data on the effectiveness and safety of electronic cigarettes for smoking cessation among adults are also limited and results are inconsistent.
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Affiliation(s)
- Carrie D Patnode
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Jillian T Henderson
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Erin L Coppola
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Joy Melnikow
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
| | - Shauna Durbin
- Center for Healthcare Policy and Research, University of California, Davis, Sacramento
| | - Rachel G Thomas
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Byanova KL, Kunisaki KM, Vasquez J, Huang L. Chronic obstructive pulmonary disease in HIV. Expert Rev Respir Med 2021; 15:71-87. [PMID: 33167728 PMCID: PMC7856058 DOI: 10.1080/17476348.2021.1848556] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023]
Abstract
Introduction: Chronic obstructive pulmonary disease (COPD) is more prevalent in people with HIV (PWH) than in the general population and leads to an increased burden of morbidity and mortality in this population. The mechanisms behind COPD development and progression in PWH are not fully elucidated, and there are no PWH-specific guidelines for COPD management. Areas covered: The goal of this broad narrative review is to review the epidemiology of COPD in PWH globally, highlight proposed pathways contributing to increased COPD prevalence and progression in PWH, discuss structural and functional changes in the lungs in this population, assesses the excess mortality and comorbidities in PWH with COPD, and address management practices for this unique population. Expert opinion: Understanding how a chronic viral infection leads to COPD, independent of cigarette smoking, is of critical scientific importance. Further research should focus on the pathophysiology of the interaction between HIV and COPD, and determine the role of disease-modifying risk factors such as opportunistic pneumonia and air pollution, as well as generate data from randomized clinical trials on the safety and efficacy of specific therapies for this vulnerable patient population.
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Affiliation(s)
- Katerina L Byanova
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ken M. Kunisaki
- Section of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Joshua Vasquez
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of Experimental Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laurence Huang
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- HIV, Infectious Diseases, and Global Medicine Division, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Moerke MJ, McMahon LR, Wilkerson JL. More than Smoke and Patches: The Quest for Pharmacotherapies to Treat Tobacco Use Disorder. Pharmacol Rev 2020; 72:527-557. [PMID: 32205338 DOI: 10.1124/pr.119.018028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Tobacco use is a persistent public health issue. It kills up to half its users and is the cause of nearly 90% of all lung cancers. The main psychoactive component of tobacco is nicotine, primarily responsible for its abuse-related effects. Accordingly, most pharmacotherapies for smoking cessation target nicotinic acetylcholine receptors (nAChRs), nicotine's major site of action in the brain. The goal of the current review is twofold: first, to provide a brief overview of the most commonly used behavioral procedures for evaluating smoking cessation pharmacotherapies and an introduction to pharmacokinetic and pharmacodynamic properties of nicotine important for consideration in the development of new pharmacotherapies; and second, to discuss current and potential future pharmacological interventions aimed at decreasing tobacco use. Attention will focus on the potential for allosteric modulators of nAChRs to offer an improvement over currently approved pharmacotherapies. Additionally, given increasing public concern for the potential health consequences of using electronic nicotine delivery systems, which allow users to inhale aerosolized solutions as an alternative to smoking tobacco, an effort will be made throughout this review to address the implications of this relatively new form of nicotine delivery, specifically as it relates to smoking cessation. SIGNIFICANCE STATEMENT: Despite decades of research that have vastly improved our understanding of nicotine and its effects on the body, only a handful of pharmacotherapies have been successfully developed for use in smoking cessation. Thus, investigation of alternative pharmacological strategies for treating tobacco use disorder remains active; allosteric modulators of nicotinic acetylcholine receptors represent one class of compounds currently under development for this purpose.
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Affiliation(s)
- M J Moerke
- Division of Preclinical Pharmacology, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland (M.J.M.) and Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida (L.R.M., J.L.W.)
| | - L R McMahon
- Division of Preclinical Pharmacology, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland (M.J.M.) and Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida (L.R.M., J.L.W.)
| | - J L Wilkerson
- Division of Preclinical Pharmacology, National Institute on Drug Abuse, National Institutes of Health, Baltimore, Maryland (M.J.M.) and Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, Florida (L.R.M., J.L.W.)
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Carney G, Bassett K, Maclure M, Taylor S, Dormuth CR. Cardiovascular and neuropsychiatric safety of smoking cessation pharmacotherapies in non-depressed adults: a retrospective cohort study. Addiction 2020; 115:1534-1546. [PMID: 32077187 DOI: 10.1111/add.14951] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/08/2019] [Accepted: 12/20/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Pharmacotherapies for smoking cessation are widely prescribed, despite substantial concerns being raised regarding the potential increased risk of cardiovascular (CV) and neuropsychiatric adverse events associated with these treatments. This study aimed to assess the relative CV and neuropsychiatric safety between varenicline and bupropion compared with nicotine replacement therapies (NRT) in adults without a recent history of depression. DESIGN Retrospective new-user cohort study. SETTING US administrative data from 2006 to 2016 covering more than 100 million individuals. PARTICIPANTS Three study cohorts of new users, aged 18 years or older, limited to patients with no diagnosis or treatment for depression in the prior 12 months. MEASUREMENTS Propensity score adjusted log-binomial regression models. The primary outcome was a composite of hospitalized CV events. Secondary outcomes included a composite of hospitalized neuropsychiatric events and individual components of the primary outcome. FINDINGS A total of 618 497 participants were included in our study cohorts. Compared with NRT (n = 32 237), varenicline (n = 454 698) was associated with a 20% lower 1-year CV risk [adjusted relative risk (RR) = 0.80, 95% confidence interval (CI) = 0.75-0.85], and bupropion (n = 131 562) was associated with a 25% lower 1-year CV risk (RR = 0.75, 95% CI = 0.69-0.81). Varenicline was associated with a 35% lower 1-year risk of neuropsychiatric hospitalization versus NRT (RR = 0.65, 95% CI = 0.59-0.72), and bupropion was associated with a 21% increase in 1-year risk of neuropsychiatric hospitalization (RR = 1.21, 95% CI = 1.09-1.35). CONCLUSION Varenicline compared with nicotine replacement therapy does not appear to be associated with an increased risk of cardiovascular or neuropsychiatric hospitalizations. Bupropion appears to be associated with a lower risk of cardiovascular hospitalization and a higher risk of neuropsychiatric hospitalization, compared with nicotine replacement therapy.
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Affiliation(s)
- Greg Carney
- Therapeutics Initiative, University of British Columbia, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Ken Bassett
- Therapeutics Initiative, University of British Columbia, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.,Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Malcolm Maclure
- Therapeutics Initiative, University of British Columbia, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Suzanne Taylor
- Lions Gate Hospital, Fraser Health Authority, Vancouver, BC, Canada
| | - Colin R Dormuth
- Therapeutics Initiative, University of British Columbia, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
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Chu S, Liang L, Jing H, Zhang D, Tong Z. Safety of varenicline as an aid to smoking cessation in professional drivers and its impact on driving behaviors: An observational cohort study of taxi drivers in Beijing. Tob Induc Dis 2020; 18:45. [PMID: 32494237 PMCID: PMC7263361 DOI: 10.18332/tid/120935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/10/2020] [Accepted: 04/21/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Varenicline is an effective smoking cessation medicine. However, the possible adverse neuropsychiatric events reported by Food and Drug Administration for varenicline may cause safety problems for professional drivers. We aimed to investigate its safety and impacts on driving behaviors among taxi drivers in Beijing, China. METHODS An observational cohort study was conducted in a smoking cessation clinic in Beijing, China, between September 2017 and April 2018. Smokers with varenicline for smoking cessation were included and categorized into taxi-driver smokers (n=103) and non-taxi-driver smokers (n=119). All participants received varenicline up to 12 weeks and five standardized counseling sessions. Treatment-related adverse events (AEs) were collected in all participants and their impacts on driving behaviors were assessed in taxi-driver smokers. Multiple logistic regression analysis was used to examine potential risk factors for vareniclinerelated somnolence/fatigue. RESULTS The incidence of most treatment-related AEs was similar between taxi-driver smokers and non-taxi-driver smokers, but treatment-related somnolence/ fatigue was more frequently reported in taxi-driver smokers (18.4% vs 6.7%; p=0.008). Most taxi-driver smokers (87.4%) reported that treatment-related AEs did not affect their driving behaviors, and no traffic accident was reported during treatment. CONCLUSIONS Varenicline appears to be a well-tolerated smoking cessation aid for Beijing taxi drivers and has less impact on driving behaviors. However, taxi-driver smokers were more likely to report somnolence/fatigue during varenicline treatment and physicians should pay more attention to this occupational population.
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Affiliation(s)
- Shuilian Chu
- Department of Clinical Epidemiology and Tobacco Dependence Treatment Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China
| | - Lirong Liang
- Department of Clinical Epidemiology and Tobacco Dependence Treatment Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China
| | - Hang Jing
- Department of Clinical Epidemiology and Tobacco Dependence Treatment Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China
| | - Di Zhang
- Department of Clinical Epidemiology and Tobacco Dependence Treatment Research, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Respiratory Medicine, Beijing, China
| | - Zhaohui Tong
- Beijing Institute of Respiratory Medicine, Beijing, China.,Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Tonstad S, Arons C, Rollema H, Berlin I, Hajek P, Fagerström K, Els C, McRae T, Russ C. Varenicline: mode of action, efficacy, safety and accumulated experience salient for clinical populations. Curr Med Res Opin 2020; 36:713-730. [PMID: 32050807 DOI: 10.1080/03007995.2020.1729708] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: Varenicline, a selective partial agonist of the α4β2 nicotinic acetylcholine receptor, is a smoking cessation pharmacotherapy that more than doubles the chance of quitting smoking at 6 months compared with placebo. This article reviews salient knowledge of the discovery, pharmacological characteristics, and the efficacy and safety of varenicline in general and in specific populations of smokers and provides recommendations to support use in clinical practice.Methods: Literature searches for varenicline were conducted using PubMed, with date limitations of 2000-2018 inclusive, using search terms covering the discovery, mechanism of action, pharmacokinetics, efficacy and safety in different populations of smokers, alternative quit approaches and combination therapy. Selection of safety and efficacy data was limited to clinical trials, meta-analyses and observational studies.Results: Standard administration of varenicline is efficacious in helping smokers to quit, including smokers with cardiovascular disease and chronic obstructive pulmonary disease. Furthermore, varenicline efficacy may be improved with pre-loading, a gradual quitting approach for smokers unwilling or unable to quit abruptly, and extended treatment in smokers who have recently quit to help maintain abstinence. Initial concerns regarding the association of varenicline with increased risk of neuropsychiatric and cardiovascular adverse events have been disproven after extensive clinical evaluations, and the benefit-risk profile of varenicline is considered favorable.Conclusions: Varenicline is efficacious and safe for all adult smokers with a range of clinical characteristics. Evidence suggests that approaches offering greater flexibility in timing and duration of treatment may further extend treatment efficacy and clinical reach.
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Affiliation(s)
- Serena Tonstad
- Department of Preventive Cardiology, Oslo University Hospital, Aker, Oslo, Norway
| | | | | | - Ivan Berlin
- Department of Pharmacology, Hôpital Pitié-Salpêtrière, Paris, France
- Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | | | - Charl Els
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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Abstract
In her Pharmaceutical Freedom, Jessica Flanigan argues that antibiotics can be regulated consistent with her otherwise largely deregulatory view with respect to pharmaceuticals and recreational drugs. I contend in this essay that the reasons for justifying antibiotic regulation are reasons that can be offered to justify the regulation of many other drugs, both pharmaceutical and recreational. After laying out the specifics of Flanigan's view, I suggest that it is amenable to the regulation of drugs like varenicline. Though such drugs can legitimately improve the quality of a patient's life by helping them quit smoking, they could be permissibly regulated if they expose others to impermissible risks. I then argue that recreational drugs like alcohol could be regulated using the same reasoning. In the penultimate section of this essay, I anticipate objections that one might have to my extension of arguments favoring antibiotic regulation to drugs correlated with aggression. Flanigan might find my extrapolation of her view as entirely plausible and accept that her view is relatively friendly to these regulations, or she might reconsider her antibiotic caveat if these regulations are overly paternalistic on her understanding. I conclude by briefly considering the benefits and drawbacks of adopting each view.
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Taylor GMJ, Itani T, Thomas KH, Rai D, Jones T, Windmeijer F, Martin RM, Munafò MR, Davies NM, Taylor AE. Prescribing Prevalence, Effectiveness, and Mental Health Safety of Smoking Cessation Medicines in Patients With Mental Disorders. Nicotine Tob Res 2020; 22:48-57. [PMID: 31289809 PMCID: PMC7073926 DOI: 10.1093/ntr/ntz072] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 05/01/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We conducted a prospective cohort study of the Clinical Practice Research Database to estimate rates of varenicline and nicotine replacement therapy (NRT) prescribing and the relative effects on smoking cessation, and mental health. METHODS We used multivariable logistic regression, propensity score matched regression, and instrumental variable analysis. Exposure was varenicline or NRT prescription. Mental disorders were bipolar, depression, neurotic disorder, schizophrenia, or prescriptions of antidepressants, antipsychotics, hypnotics/anxiolytics, mood stabilizers. Outcomes were smoking cessation, and incidence of neurotic disorder, depression, prescription of antidepressants, or hypnotics/anxiolytics. Follow-ups were 3, 6, and 9 months, and at 1, 2, and 4 years. RESULTS In all patients, NRT and varenicline prescribing declined during the study period. Seventy-eight thousand four hundred fifty-seven smokers with mental disorders aged ≥18 years were prescribed NRT (N = 59 340) or varenicline (N = 19 117) from September 1, 2006 to December 31, 2015. Compared with smokers without mental disorders, smokers with mental disorders had 31% (95% CI: 29% to 33%) lower odds of being prescribed varenicline relative to NRT, but had 19% (95% CI: 15% to 24%) greater odds of quitting at 2 years when prescribed varenicline relative to NRT. Overall, varenicline was associated with decreased or similar odds of worse mental health outcomes than NRT in patients both with and without mental disorders, although there was some variation when analyses were stratified by mental disorder subgroup. CONCLUSIONS Smoking cessation medication prescribing may be declining in primary care. Varenicline was more effective than NRT for smoking cessation in patients with mental disorders and there is not clear consistent evidence that varenicline is adversely associated with poorer mental health outcomes. IMPLICATIONS Patients with mental disorders were less likely to be prescribed varenicline than NRT. We triangulated results from three analytical techniques. We found that varenicline was more effective than NRT for smoking cessation in patients with mental disorders. Varenicline was generally associated with similar or decreased odds of poorer mental health outcomes (ie, improvements in mental health) when compared with NRT. We report these findings cautiously as our data are observational and are at risk of confounding.
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Affiliation(s)
- Gemma M J Taylor
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Taha Itani
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
| | - Kyla H Thomas
- Bristol Medical School, Population Health Sciences, Canynge Hall, University of Bristol, Bristol, UK
| | - Dheeraj Rai
- Centre for Academic Mental Health; Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Tim Jones
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Frank Windmeijer
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- Department of Economics, University of Bristol, Bristol, UK
| | - Richard M Martin
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, Canynge Hall, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Marcus R Munafò
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
| | - Neil M Davies
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Medical School, Population Health Sciences, Canynge Hall, University of Bristol, Bristol, UK
| | - Amy E Taylor
- Bristol Medical School, Population Health Sciences, Canynge Hall, University of Bristol, Bristol, UK
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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Patterson F, Grandner MA, Malone SK, Rizzo A, Davey A, Edwards DG. Sleep as a Target for Optimized Response to Smoking Cessation Treatment. Nicotine Tob Res 2020; 21:139-148. [PMID: 29069464 DOI: 10.1093/ntr/ntx236] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 10/19/2017] [Indexed: 12/23/2022]
Abstract
Declining national rates of current tobacco use to an all-time low of 15.1% represents a public health victory. Undermining this progress, however, are smoking rates of up to 50% among high-risk, low-income populations. Current FDA-approved treatments for nicotine dependence are ineffective with between 70-95% of treatment-seekers relapsing within the first year of attempted abstinence. Thus, identification of novel intervention targets to optimize response to currently available treatments for nicotine dependence is a critical next step. One such target may be sleep insomnia. Insomnia is a clinically verified nicotine withdrawal symptom but, to date, addressing insomnia or other sleep disturbance symptoms as an adjunctive smoking cessation therapy has yet to be fully considered. To this end, this manuscript presents a narrative review of: (1) sleep continuity and architecture in smokers versus nonsmokers; (2) effects of nicotine abstinence on sleep; (3) possible mechanisms linking sleep with smoking cessation outcomes; (4) plausible adjunctive sleep therapies to promote smoking cessation; (5) possible treatments for unhealthy sleep in smokers; and (6) directions for future research. Taken together, this will provide conceptual support for sleep therapy as an adjunctive treatment for smoking cessation. Implications This narrative literature review presents a comprehensive discussion of the relationship between habitual sleep and cigarette smoking. The extent to which unhealthy sleep in smokers may be a viable intervention target for promoting response to smoking cessation treatment is considered. Ultimately, this review provides conceptual support for sleep therapy as an adjunctive treatment for smoking cessation.
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Affiliation(s)
- Freda Patterson
- College of Health Sciences, University of Delaware, Newark, DE
| | - Michael A Grandner
- Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ
| | - Susan K Malone
- Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Albert Rizzo
- Christiana Care Health System, Pulmonary and Critical Care Medicine, Newark, DE
| | - Adam Davey
- College of Health Sciences, University of Delaware, Newark, DE
| | - David G Edwards
- College of Health Sciences, University of Delaware, Newark, DE
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Barnes TR, Drake R, Paton C, Cooper SJ, Deakin B, Ferrier IN, Gregory CJ, Haddad PM, Howes OD, Jones I, Joyce EM, Lewis S, Lingford-Hughes A, MacCabe JH, Owens DC, Patel MX, Sinclair JM, Stone JM, Talbot PS, Upthegrove R, Wieck A, Yung AR. Evidence-based guidelines for the pharmacological treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2020; 34:3-78. [PMID: 31829775 DOI: 10.1177/0269881119889296] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
These updated guidelines from the British Association for Psychopharmacology replace the original version published in 2011. They address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting was held in 2017, involving experts in schizophrenia and its treatment. They were asked to review key areas and consider the strength of the evidence on the risk-benefit balance of pharmacological interventions and the clinical implications, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. The guidelines cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. It is hoped that the practice recommendations presented will support clinical decision making for practitioners, serve as a source of information for patients and carers, and inform quality improvement.
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Affiliation(s)
- Thomas Re Barnes
- Emeritus Professor of Clinical Psychiatry, Division of Psychiatry, Imperial College London, and Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Richard Drake
- Clinical Lead for Mental Health in Working Age Adults, Health Innovation Manchester, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Carol Paton
- Joint-head of the Prescribing Observatory for Mental Health, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Stephen J Cooper
- Emeritus Professor of Psychiatry, School of Medicine, Queen's University Belfast, Belfast, UK
| | - Bill Deakin
- Professor of Psychiatry, Neuroscience & Psychiatry Unit, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - I Nicol Ferrier
- Emeritus Professor of Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine J Gregory
- Honorary Clinical Research Fellow, University of Manchester and Higher Trainee in Child and Adolescent Psychiatry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter M Haddad
- Honorary Professor of Psychiatry, Division of Psychology and Mental Health, University of Manchester, UK and Senior Consultant Psychiatrist, Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Oliver D Howes
- Professor of Molecular Psychiatry, Imperial College London and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian Jones
- Professor of Psychiatry and Director, National Centre of Mental Health, Cardiff University, Cardiff, UK
| | - Eileen M Joyce
- Professor of Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Shôn Lewis
- Professor of Adult Psychiatry, Faculty of Biology, Medicine and Health, The University of Manchester, UK, and Mental Health Academic Lead, Health Innovation Manchester, Manchester, UK
| | - Anne Lingford-Hughes
- Professor of Addiction Biology and Honorary Consultant Psychiatrist, Imperial College London and Central North West London NHS Foundation Trust, London, UK
| | - James H MacCabe
- Professor of Epidemiology and Therapeutics, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Honorary Consultant Psychiatrist, National Psychosis Service, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - David Cunningham Owens
- Professor of Clinical Psychiatry, University of Edinburgh. Honorary Consultant Psychiatrist, Royal Edinburgh Hospital, Edinburgh, UK
| | - Maxine X Patel
- Honorary Clinical Senior Lecturer, King's College London, Institute of Psychiatry, Psychology and Neuroscience and Consultant Psychiatrist, Oxleas NHS Foundation Trust, London, UK
| | - Julia Ma Sinclair
- Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James M Stone
- Clinical Senior Lecturer and Honorary Consultant Psychiatrist, King's College London, Institute of Psychiatry, Psychology and Neuroscience and South London and Maudsley NHS Trust, London, UK
| | - Peter S Talbot
- Senior Lecturer and Honorary Consultant Psychiatrist, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rachel Upthegrove
- Professor of Psychiatry and Youth Mental Health, University of Birmingham and Consultant Psychiatrist, Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angelika Wieck
- Honorary Consultant in Perinatal Psychiatry, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison R Yung
- Professor of Psychiatry, University of Manchester, School of Health Sciences, Manchester, UK and Centre for Youth Mental Health, University of Melbourne, Australia, and Honorary Consultant Psychiatrist, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Walker LC, Lawrence AJ. Allosteric modulation of muscarinic receptors in alcohol and substance use disorders. FROM STRUCTURE TO CLINICAL DEVELOPMENT: ALLOSTERIC MODULATION OF G PROTEIN-COUPLED RECEPTORS 2020; 88:233-275. [DOI: 10.1016/bs.apha.2020.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Itani T, Rai D, Jones T, Taylor GMJ, Thomas KH, Martin RM, Munafò MR, Davies NM, Taylor AE. Long-term effectiveness and safety of varenicline and nicotine replacement therapy in people with neurodevelopmental disorders: A prospective cohort study. Sci Rep 2019; 9:19488. [PMID: 31862899 PMCID: PMC6925148 DOI: 10.1038/s41598-019-54727-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/05/2019] [Indexed: 11/12/2022] Open
Abstract
This study aimed to determine the effectiveness and safety of varenicline versus NRT for smoking cessation in people with neurodevelopmental disorders, compared to those without, at up to four years after exposure. We analysed electronic medical records from the Clinical Practice Research Datalink using three different statistical approaches: multivariable logistic regression, propensity score matching (PSM), and instrumental variable analysis. Exposure was prescription of varenicline versus NRT and the primary outcome was smoking cessation at 2-years. We included 235,314 people aged 18 and above with eligible smoking cessation prescriptions in the effectiveness analysis. Smokers with neurodevelopmental disorders were 48% less likely (95% confidence interval: 42%, 54%) to be prescribed varenicline than NRT, compared to smokers without neurodevelopmental disorders. At 2-year follow-up, smokers with neurodevelopmental disorders prescribed varenicline were 38% more likely to quit smoking (95% confidence interval: 6%, 78%). Similar results were obtained using PSM and instrumental variable analyses. There was little evidence showing that varenicline increased the likelihood of mental health related adverse events in people with neurodevelopmental disorders. Varenicline is less likely to be prescribed to people with neurodevelopmental disorders despite results suggesting it is more effective than NRT and little evidence of increased likelihood of mental health related adverse events.
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Affiliation(s)
- Taha Itani
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, BS8 2BN, United Kingdom
- School of Psychological Science, 12a Priory Road, Bristol, BS8 1TU, United Kingdom
| | - Dheeraj Rai
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom
- Avon & Wiltshire Partnership NHS Mental Health Trust, Bristol, UK
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
| | - Tim Jones
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Gemma M J Taylor
- Addiction and Mental Health Group (AIM) Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom
| | - Kyla H Thomas
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, United Kingdom
| | - Richard M Martin
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, BS8 2BN, United Kingdom
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, United Kingdom
| | - Marcus R Munafò
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, BS8 2BN, United Kingdom
- School of Psychological Science, 12a Priory Road, Bristol, BS8 1TU, United Kingdom
| | - Neil M Davies
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, Bristol, BS8 2BN, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, United Kingdom
| | - Amy E Taylor
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, United Kingdom.
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Leung MKW, Bai D, Yip BHK, Fong MY, Lai PMH, Lai P, Lai ISY, Lam ZHW, Leung ATF, To DKY, Wong MT, Wong TK, Chao DVK. Combined nicotine patch with gum versus nicotine patch alone in smoking cessation in Hong Kong primary care clinics: a randomised controlled trial. BMC Public Health 2019; 19:1302. [PMID: 31619205 PMCID: PMC6796337 DOI: 10.1186/s12889-019-7634-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 09/16/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The prevalence of daily cigarette smoking has dropped to 10% in Hong Kong (HK) in 2017, however, smoking still kills 5700 persons per year. Studies suggest that abstinence rates are higher with combined NRT than single NRT, although local data on safety and benefits of combined NRT are lacking. The aim of this study is to compare the effectiveness of combined NRT with single NRT among HK Chinese. METHODS This is a one-year, two-arm, parallel randomised trial. Five hundred sixty smokers, who smoked ≥10 cigarettes/day for ≥1 year, were randomized to combined and single NRT. Combined NRT group received counseling and nicotine patch & gum. Single NRT group received counselling and nicotine patch. Primary outcome was abstinence rate measured as self-reported 7-day point prevalence with CO validated at 52 weeks. Secondary outcomes included smoking abstinence rates at 4, 12, & 26 weeks. Crude odds ratio and p-value were reported from logistic regression without adjustment; for trend analysis, adjusted odds ratio (AOR) and p-value were reported from Generalized Estimating Equation (GEE) (controlling for time). All AORs were adjusted for age, sex, baseline CO and clusters. RESULTS Abstinence rates at 4, 12, 26 and 52 weeks were all higher in the combined NRT group (35.8, 21.9, 16.8, 20.1%) compared with the single NRT group (28, 16.8, 11.2, 14.3%). At 4 weeks, combined NRT group was more likely to quit smoking (OR 1.43, 95% CI, 1.00 to 2.05) than the single NRT group. From GEE analysis, combined NRT group had a significantly higher abstinence rate (23.6%) than the single NRT group (17.6%) across repeated measures at all-time points. Combined NRT group was more likely to quit smoking (OR 1.43, 95% CI, 1.15 to 1.77). No significant difference in the side effect profile was detected between groups. CONCLUSIONS Smokers given 8 weeks of combined NRT were more likely to quit smoking at 4, 12, 26 and 52 weeks compared with single NRT. Combined NRT was as well tolerated as single NRT and it should be further promoted in our community. TRIAL REGISTRATION NCT03836560 from ClinicalTrial.gov , 9 Feb 2019.
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Affiliation(s)
- Maria K. W. Leung
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong, China
| | - Dan Bai
- Division of Family Medicine and Primary Health Care, Chinese University of Hong Kong, Hong Kong, China
| | - Benjamin H. K. Yip
- Division of Family Medicine and Primary Health Care, Chinese University of Hong Kong, Hong Kong, China
| | - M. Y. Fong
- Department of Family Medicine and Primary Health Care, Kowloon East Cluster, Hospital Authority, Hong Kong, China
| | - Petty M. H. Lai
- Occupational Therapy Department, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Phoebe Lai
- Department of Family Medicine, Kowloon Central Cluster, Hospital Authority, Hong Kong, China
| | - Irene S. Y. Lai
- Department of Family Medicine, Hong Kong East Cluster, Hospital Authority, Hong Kong, China
| | - Zoe H. W. Lam
- Department of Family Medicine, Hong Kong East Cluster, Hospital Authority, Hong Kong, China
| | - Andrew T. F. Leung
- Occupational Therapy Department, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Dorothy K Y To
- Department of Family Medicine, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - M. T. Wong
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong, China
| | - T. K. Wong
- Department of Family Medicine and Primary Health Care, Kowloon East Cluster, Hospital Authority, Hong Kong, China
| | - David V. K. Chao
- Department of Family Medicine and Primary Health Care, Kowloon East Cluster, Hospital Authority, Hong Kong, China
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40
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Monárrez-Espino J, Galanti MR, Hansson J, Janszky I, Söderberg-Löfdal K, Möller J. Treatment With Bupropion and Varenicline for Smoking Cessation and the Risk of Acute Cardiovascular Events and Injuries: a Swedish Case-Crossover Study. Nicotine Tob Res 2019; 20:606-613. [PMID: 28595356 DOI: 10.1093/ntr/ntx131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 06/07/2017] [Indexed: 11/12/2022]
Abstract
Introduction Bupropion and varenicline are non-nicotine medications used for smoking cessation that mitigate craving and withdrawal symptoms. We aim to investigate whether these drugs increase the risk of selected acute adverse outcomes when used in medical practice. Methods Population-based case-crossover design using data from Swedish health and administrative registers. Adult individuals diagnosed with acute myocardial infarction, stroke, suicide, suicide attempt, fall injury, or that suffered a road traffic crash from 01.10.2006 for bupropion, or from 01.03.2008 for varenicline, until 31.12.2013 were included. Different lengths of exposure periods were analyzed within the 12-week hazard period prior to the adverse outcome (1-14, 15-28, and 29-84 days). The control period was matched using the interval preceding the hazard period (85-168 days), and breaking it up into equivalent periods (85-98, 99-112, and 113-168 days). Conditional logistic regression with each case considered as one stratum was used to estimate adjusted odds ratios (OR) and confidence intervals (CI). Results Neither medication was associated with consistent higher risks for any of the adverse outcomes. For bupropion and varenicline, respectively, in the 1-14 days hazard period, OR (95% CI) were: myocardial infarction 1.14 (0.55 to 2.34) and 1.06 (0.70 to 1.62); stroke 1.16 (0.39 to 3.47) and 1.26 (0.72 to 2.17), and traffic crashes 0.85 (0.39 to 1.85) and 1.48 (0.90 to 2.41). In the other periods, ORs were similar or even lower. For falls and suicidal events ORs were generally below one for both drugs. Conclusion The available evidence suggests that if prescription guidelines are properly followed regarding potential contraindications both of these medications could be considered relatively safe. Implications The reliable exposure and diagnosis assessment used in this nationwide register-based study, along with the number of cases gathered makes this sample one of the largest of its type to assess potential side effects associated with the use of these drugs. Neither medication was associated with consistent higher risks for any of the adverse outcomes studied.
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Affiliation(s)
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Jenny Hansson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Imre Janszky
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology.,Regional center for health care improvement, St Olav Hospital, Trondheim, Norway
| | - Karin Söderberg-Löfdal
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden.,Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jette Möller
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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41
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Windle SB, Dehghani P, 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, Eisenberg MJ. Smoking abstinence 1 year after acute coronary syndrome: follow-up from a randomized controlled trial of varenicline in patients admitted to hospital. CMAJ 2019; 190:E347-E354. [PMID: 29581161 DOI: 10.1503/cmaj.170377] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Patients who continue to smoke after acute coronary syndrome are at increased risk of reinfarction and death. We previously found use of varenicline to increase abstinence 24 weeks after acute coronary syndrome; here we report results through 52 weeks. METHODS The EVITA trial was a multicentre, double-blind, randomized, placebo-controlled trial of varenicline for smoking cessation in patients admitted to hospital with acute coronary syndrome. Participants were randomly assigned (1:1) to receive varenicline or placebo for 12 weeks, in conjunction with low-intensity counselling. Smoking abstinence was assessed via 7-day recall, with biochemical validation using exhaled carbon monoxide. Participants lost to follow-up or withdrawn were assumed to have returned to smoking. RESULTS Among the 302 participants, abstinence declined over the course of the trial, with 34.4% abstinent 52 weeks after acute coronary syndrome. Compared with placebo, point estimates suggest use of varenicline increased point-prevalence abstinence (39.9% v. 29.1%, difference 10.7%, 95% confidence interval [CI] 0.01% to 21.44%; number needed to treat 10), continuous abstinence (31.1% v. 21.2%, difference 9.9%, 95% CI -0.01% to 19.8%) and reduction in daily cigarette smoking by 50% or greater (57.8% v. 49.7%, difference 8.1%, 95% CI -3.1% to 19.4%). Varenicline and placebo groups had similar occurrence of serious adverse events (24.5% v. 21.9%, risk difference 2.7%, 95% CI -7.3% to 12.6%) and major adverse cardiovascular events (8.6% v. 9.3%, risk difference -0.7%, 95% CI -7.8% to 6.5%). INTERPRETATION Varenicline was efficacious for smoking cessation in this high-risk patient population. However, 60% of patients who received treatment with varenicline still returned to smoking. Trial registration: ClinicalTrials.gov, no. NCT00794573.
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Affiliation(s)
- Sarah B Windle
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Payam Dehghani
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Nathalie Roy
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Wayne Old
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - François R Grondin
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Iqbal Bata
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Ayman Iskander
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Claude Lauzon
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Nalin Srivastava
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Adam Clarke
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Daniel Cassavar
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Danielle Dion
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Herbert Haught
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Shamir R Mehta
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Jean-François Baril
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Charles Lambert
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Mina Madan
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Beth L Abramson
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont
| | - Mark J Eisenberg
- Jewish General Hospital, McGill University (Windle, Eisenberg), Montréal, Que.; Prairie Vascular Research Network (Dehghani), University of Saskatchewan, Regina, Sask.; Centre de santé et de services sociaux de Chicoutimi (Roy), Chicoutimi, Que.; Sentara Cardiovascular Research Institute (Old), Norfolk, Va.; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Grondin), Hôtel-Dieu de Lévis site, Lévis, Que.; Queen Elizabeth II Health Sciences Centre (Bata), Halifax, NS; SJH Cardiology Associates and St. Joseph's Hospital Health Centre (Iskander), Liverpool, NY; Centre intégré de santé et de services sociaux Chaudière-Appalaches (Lauzon), Hôpital de Saint-Georges site, Thetford Mines, Que.; Spartanburg Regional Medical Center (Srivastava), Spartanburg, SC; Valley Regional Hospital (Clarke), Kentville, NS; Toledo Hospital (Cassavar), Toledo, Ohio; Centre de santé et de services sociaux de Beauce (Dion), Beauce, Que.; Heart Center Research (Haught), Huntsville, Ala.; McMaster University and Hamilton Health Sciences (Mehta), Hamilton, Ont.; Dr. Georges-L.-Dumont University Hospital Centre (Baril), Moncton, NB; Florida Hospital Pepin Heart Institute (Lambert), Tampa, Fla.; Sunnybrook Health Sciences Centre (Madan), University of Toronto, Toronto, Ont.; St. Michael's Hospital (Abramson), Toronto, Ont.
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Zaccarelli-Magalhães J, Sandini TM, de Abreu GR, Petrocelli BM, Moreira N, Reis-Silva TM, Lebrun I, Flório JC, Ricci EL, Fukushima AR, Faria Waziry PA, de Souza Spinosa H. Prolonged exposure of rats to varenicline increases anxiety and alters serotonergic system, but has no effect on memory. Pharmacol Biochem Behav 2019; 181:1-8. [PMID: 30946884 DOI: 10.1016/j.pbb.2019.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/26/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022]
Abstract
Varenicline is a drug used for smoking addiction cessation treatment and acts as a partial agonist of nicotinic cholinergic receptors. Recent clinical trial data support use of varenicline for treatment of conditions/addictions that are not related to smoking cessation. Considering the importance of this issue and the need for new studies on its effects, especially on behavior, more studies using animal models are necessary. Thus, the aim of this study was to evaluate the effects of prolonged exposure to varenicline in anxiety-like behavior and memory, as well as in cerebral neurochemistry of rats. Male rats received three different doses of varenicline: 0.03 (therapeutic dose for humans), 0.1 and 0.3 mg/kg orally (gavage) for 30 days. Animal behavior was analyzed through open field, elevated plus maze, light/dark box, social interaction, Barnes maze and novel object recognition tests. Neurotransmitter levels and their metabolites in different brain structures (hippocampus, striatum and frontal cortex) were measured. Results showed that prolonged exposure of rats to varenicline: 1) did not interfere in motor activity, but caused an anxiogenic effect on elevated plus maze, light/dark box and social interaction testes; 2) did not alter memory; and 3) promoted alterations on serotoninergic system in the striatum and frontal cortex. In conclusion, compilation of the data indicates that prolonged exposure of rats to varenicline promoted anxiogenic effects and alteration in serotonergic system, which corroborated behavioral findings.
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Affiliation(s)
- Julia Zaccarelli-Magalhães
- Graduate Program of Experimental and Comparative Pathology, Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil.
| | - Thaisa Meira Sandini
- Graduate Program of Toxicology and Toxicological Analysis, School of Pharmaceutical Science, University of São Paulo, Av. Prof. Dr. Lineu Prestes, 580, 05508-000 São Paulo, Brazil.
| | - Gabriel Ramos de Abreu
- Graduate Program of Experimental and Comparative Pathology, Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil; Health Science Institute, Presbiterian Mackenzie University, Rua da Consolação, 930, 01302-907 São Paulo, Brazil
| | - Bianca Maria Petrocelli
- Health Science Institute, Presbiterian Mackenzie University, Rua da Consolação, 930, 01302-907 São Paulo, Brazil
| | - Natalia Moreira
- Graduate Program of Experimental and Comparative Pathology, Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil.
| | - Thiago Moirinho Reis-Silva
- Department of Neuroscience, Institute of Psychology, University of São Paulo, Av. Prof. Dr. Melo de Morais, 1721, 05508-030 São Paulo, Brazil.
| | - Ivo Lebrun
- Laboratory of Biochemistry and Biophysics, Butantan Institute, 05503-900 São Paulo, Brazil.
| | - Jorge Camilo Flório
- Graduate Program of Experimental and Comparative Pathology, Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil.
| | - Esther Lopes Ricci
- Health Science Institute, Presbiterian Mackenzie University, Rua da Consolação, 930, 01302-907 São Paulo, Brazil
| | - André Rinaldi Fukushima
- Graduate Program of Experimental and Comparative Pathology, Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil; São Bento's College, Largo de São Bento s/no, 01029-010 São Paulo, Brazil.
| | - Paula A Faria Waziry
- Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, 3200 S. University Drive, Fort Lauderdale, Florida 33328, United States of America.
| | - Helenice de Souza Spinosa
- Graduate Program of Experimental and Comparative Pathology, Department of Pathology, School of Veterinary Medicine and Animal Science, University of São Paulo, Av. Prof. Dr. Orlando Marques de Paiva, 87, 05508-270 São Paulo, Brazil.
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Chen XZ, Zhang RY, Wang XF, Yin XG, Wang J, Wang YC, Liu X, Du JJ, Liu Z, Guo J. Peptide-free Synthetic Nicotine Vaccine Candidates with α-Galactosylceramide as Adjuvant. Mol Pharm 2019; 16:1467-1476. [DOI: 10.1021/acs.molpharmaceut.8b01095] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Xiang-Zhao Chen
- Key Laboratory of Pesticide & Chemical Biology of Ministry of Education, Hubei International Scientific and Technological Cooperation Base of Pesticide and Green Synthesis, International Joint Research Center for Intelligent Biosensing Technology and Health, College of Chemistry, Central China Normal University, Wuhan, Hubei 430079, P. R. China
| | - Ru-Yan Zhang
- Key Laboratory of Pesticide & Chemical Biology of Ministry of Education, Hubei International Scientific and Technological Cooperation Base of Pesticide and Green Synthesis, International Joint Research Center for Intelligent Biosensing Technology and Health, College of Chemistry, Central China Normal University, Wuhan, Hubei 430079, P. R. China
| | - Xi-Feng Wang
- Key Laboratory of Pesticide & Chemical Biology of Ministry of Education, Hubei International Scientific and Technological Cooperation Base of Pesticide and Green Synthesis, International Joint Research Center for Intelligent Biosensing Technology and Health, College of Chemistry, Central China Normal University, Wuhan, Hubei 430079, P. R. China
| | - Xu-Guang Yin
- Key Laboratory of Pesticide & Chemical Biology of Ministry of Education, Hubei International Scientific and Technological Cooperation Base of Pesticide and Green Synthesis, International Joint Research Center for Intelligent Biosensing Technology and Health, College of Chemistry, Central China Normal University, Wuhan, Hubei 430079, P. R. China
| | - Jian Wang
- Key Laboratory of Pesticide & Chemical Biology of Ministry of Education, Hubei International Scientific and Technological Cooperation Base of Pesticide and Green Synthesis, International Joint Research Center for Intelligent Biosensing Technology and Health, College of Chemistry, Central China Normal University, Wuhan, Hubei 430079, P. R. China
| | - Ya-Cong Wang
- Key Laboratory of Pesticide & Chemical Biology of Ministry of Education, Hubei International Scientific and Technological Cooperation Base of Pesticide and Green Synthesis, International Joint Research Center for Intelligent Biosensing Technology and Health, College of Chemistry, Central China Normal University, Wuhan, Hubei 430079, P. R. China
| | - Xiu Liu
- Key Laboratory of Pesticide & Chemical Biology of Ministry of Education, Hubei International Scientific and Technological Cooperation Base of Pesticide and Green Synthesis, International Joint Research Center for Intelligent Biosensing Technology and Health, College of Chemistry, Central China Normal University, Wuhan, Hubei 430079, P. R. China
| | - Jing-Jing Du
- Key Laboratory of Pesticide & Chemical Biology of Ministry of Education, Hubei International Scientific and Technological Cooperation Base of Pesticide and Green Synthesis, International Joint Research Center for Intelligent Biosensing Technology and Health, College of Chemistry, Central China Normal University, Wuhan, Hubei 430079, P. R. China
| | - Zheng Liu
- Key Laboratory of Pesticide & Chemical Biology of Ministry of Education, Hubei International Scientific and Technological Cooperation Base of Pesticide and Green Synthesis, International Joint Research Center for Intelligent Biosensing Technology and Health, College of Chemistry, Central China Normal University, Wuhan, Hubei 430079, P. R. China
| | - Jun Guo
- Key Laboratory of Pesticide & Chemical Biology of Ministry of Education, Hubei International Scientific and Technological Cooperation Base of Pesticide and Green Synthesis, International Joint Research Center for Intelligent Biosensing Technology and Health, College of Chemistry, Central China Normal University, Wuhan, Hubei 430079, P. R. China
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Yıldırım Dİ, Hayıroğlu Mİ, Ünal N, Eryılmaz MA. Evaluation of varenicline usage on ventricular repolarization after smoking cessation. Ann Noninvasive Electrocardiol 2019; 24:e12609. [PMID: 30417951 PMCID: PMC6931874 DOI: 10.1111/anec.12609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/25/2018] [Accepted: 10/08/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Varenicline, which is a selective partial agonist of the alpha4-beta2 nicotinic acetylcholine receptor, is used for the smoking cessation pharmacotherapy. Cardiovascular adverse effects have been reported after varenicline usage in patients who stop smoking. We investigated the effect of varenicline usage on ventricular repolarization after smoking cessation. METHODS In this prospective cohort study, we evaluated the cardiac arrhythmic effects of varenicline by comparing smoking patients (n = 214) before and after varenicline usage. Varenicline administered patients were also compared to ex-smoker individuals (n = 50) who quit smoking without varenicline usage in terms of ventricular repolarization parameters. RESULTS After calculated according to Fridericia's and Framingham's formulas, QTc intervals were significantly increased when patients compared before and after smoking cessation with varenicline (402.9 ± 24.5 ms vs. 409.1 ± 25.0 ms p < 0.001 and 376.5 ± 15.2 ms, vs. 380.6 ± 13.5 ms; p < 0.001, respectively). There was no arrhythmic event during the follow-up. The change in Tp-e and QTc following varenicline usage was negatively correlated with the smoking packet/year. (ρ: -0.443, p < 0.001 and ρ = -0.601, p < 0.001) CONCLUSION: Varenicline usage was demonstrated to prolong ventricular repolarization parameters similar to animal studies. Varenicline may have a role to predispose cardiac dysrhythmias after utilization in smoking cessation.
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Affiliation(s)
- Duygu İlke Yıldırım
- Department of Family MedicineHealth Sciences University Konya Training and Research HospitalKonyaTurkey
| | - Mert İlker Hayıroğlu
- Department of CardiologyDr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Neriman Ünal
- Department of Family MedicineHealth Sciences University Konya Training and Research HospitalKonyaTurkey
| | - Mehmet Ali Eryılmaz
- Department of General SurgeryHealth Sciences University Konya Training and Research HospitalKonyaTurkey
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Yue X, Guo JJ, Wigle PR. Trends in Utilization, Spending, and Prices of Smoking-Cessation Medications in Medicaid Programs: 25 Years Empirical Data Analysis, 1991-2015. AMERICAN HEALTH & DRUG BENEFITS 2018; 11:275-285. [PMID: 30464795 PMCID: PMC6207314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/12/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Smoking remains the single largest preventable cause of death and disease. Smoking-cessation medications provide patients a multitude of benefits and can prevent certain diseases, including some cancers. Because of the limited amount of studies on smoking-cessation medications, we wanted to find general trends about the use of these medications. OBJECTIVE To examine trends in the utilization, pharmacy reimbursement, and prices of smoking-cessation medications and nicotine replacement therapy in the US Medicaid-covered population. METHODS Using national summary files for outpatient drug utilization and expenditure, we extracted data on smoking-cessation medications from the Centers for Medicare & Medicaid Services in the 25 years from January 1991 through June 2015. We conducted a retrospective drug utilization study to examine the annual (or quarterly) trends of the number of prescriptions, reimbursement expenditures, and the prices of smoking-cessation medications. The study drugs included varenicline (Chantix), bupropion (Zyban), and nicotine. We calculated per-prescription pharmacy reimbursement, which was used as a proxy for drug price, as the total quarterly expenditure for the drug, divided by the total number of prescriptions. All expenditures were inflated to 2015 US dollars using the medical services component of the Consumer Price Index. RESULTS The total number of prescriptions for smoking-cessation medications increased rapidly from 46,396 in 1991 to 942,562 in 2014, an increase of more than 1931%. During the same period, the total pharmacy reimbursement for smoking-cessation medications in Medicaid increased by 3562%, from approximately $2.8 million in 1991 to approximately $101 million in 2014. The use of the nonnicotine prescription drugs varenicline and bupropion also increased rapidly, with a high cost expenditure. The price per nonnicotine prescription drug increased over time, ranging from approximately $169 for bupropion to approximately $251 for varenicline in 2015. CONCLUSIONS The substantial increase in nonnicotine prescription drugs and nicotine replacement therapy between 2007 and 2015 may be attributed to smoking-cessation participants nationwide. Cost-containment policies might have inadvertently prevented Medicaid-covered smokers from obtaining appropriate pharmacotherapy.
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Affiliation(s)
- Xiaomeng Yue
- PhD Student, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, OH
| | - Jeff Jianfei Guo
- Professor of Pharmacoeconomics & Pharmacoepidemiology, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, OH
| | - Patricia R Wigle
- Professor, Pharmacy Practice, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, OH
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Denton TT, Srivastava P, Xia Z, Chen G, Watson CJW, Wynd A, Lazarus P. Identification of the 4-Position of 3-Alkynyl and 3-Heteroaromatic Substituted Pyridine Methanamines as a Key Modification Site Eliciting Increased Potency and Enhanced Selectivity for Cytochrome P-450 2A6 Inhibition. J Med Chem 2018; 61:7065-7086. [PMID: 29995408 DOI: 10.1021/acs.jmedchem.8b00084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cigarette smoking causes nearly one in every five deaths in the United States. The development of a specific inhibitor of cytochrome P450 2A6 (CYP2A6), the major nicotine-metabolizing enzyme in humans, which could be prescribed for the cessation of cigarette smoking, has been undertaken. To further refine the structure activity relationship of CYP2A6, previously synthesized 3-alkynyl and 3-heteroaromatic substituted pyridine methanamines were used as lead compounds. Isosteric pyridine replacement and appendage of all available positions around the pyridine ring with a methyl group was performed to identify a modification that would increase CYP2A6 inhibition potency, which led to 4g (IC50 = 0.055 mM) as a primary analogue. Potent compounds were evaluated for CYP selectivity, human liver microsomal half-life, and compliance with the rules of five. Top compounds (i.e., 6i, IC50 = 0.017 mM, >120 min half-life) are poised for further development as treatments for smoking and tobacco use cessation.
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Affiliation(s)
- Travis T Denton
- Department of Pharmaceutical Sciences , College of Pharmacy, Washington State University , Spokane , Washington 99202 , United States
| | - Pramod Srivastava
- Department of Pharmaceutical Sciences , College of Pharmacy, Washington State University , Spokane , Washington 99202 , United States
| | - Zuping Xia
- Department of Pharmaceutical Sciences , College of Pharmacy, Washington State University , Spokane , Washington 99202 , United States
| | - Gang Chen
- Department of Pharmaceutical Sciences , College of Pharmacy, Washington State University , Spokane , Washington 99202 , United States
| | - Christy J W Watson
- Department of Pharmaceutical Sciences , College of Pharmacy, Washington State University , Spokane , Washington 99202 , United States
| | - Alec Wynd
- Department of Pharmaceutical Sciences , College of Pharmacy, Washington State University , Spokane , Washington 99202 , United States
| | - Philip Lazarus
- Department of Pharmaceutical Sciences , College of Pharmacy, Washington State University , Spokane , Washington 99202 , United States
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Briones M, Shoptaw S, Cook R, Worley M, Swanson AN, Moody DE, Fang WB, Tsuang J, Furst B, Heinzerling K. Varenicline treatment for methamphetamine dependence: A randomized, double-blind phase II clinical trial. Drug Alcohol Depend 2018; 189:30-36. [PMID: 29860057 PMCID: PMC6391991 DOI: 10.1016/j.drugalcdep.2018.04.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/26/2018] [Accepted: 04/28/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies have suggested that varenicline, an α4β2 nicotinic receptor partial agonist, and α7 nicotinic receptor full agonist, may be effective for the treatment of methamphetamine (MA) dependence due to dopaminergic effects, relief of glutamatergic and cognitive dysfunction, and activation of nicotinic cholinergic systems. This study aimed to determine if varenicline (1 mg BID) resulted in reduced methamphetamine use compared to placebo among treatment-seeking MA-dependent volunteers. METHODS Treatment-seeking MA-dependent volunteers were randomized to varenicline 1 mg twice daily (n = 27) or placebo (n = 25) and cognitive behavioral therapy for 9 weeks. The primary outcomes were the proportion of participants achieving end-of-treatment-abstinence (EOTA, MA-negative urine specimens during weeks 8 and 9) and the treatment effectiveness score (TES, number of MA-negative urine specimens) for varenicline versus placebo. RESULTS There was no significant difference in EOTA between varenicline (15%, 4/27) and placebo (20%, 5/25; p = 0.9). There was some suggestion that urinary confirmed medication compliance corresponded with EOTA in the varenicline condition, though it did not reach statistical significance, OR = 1.57 for a 100 ng/ml increase in urine varenicline, p = 0.10, 95% CI (0.99, 3.02). There was no significant difference in mean TES in the varenicline condition (8.6) compared to the placebo condition (8.1), and treatment condition was not a statistically significant predictor of TES, IRR = 1.01, p = 0.9, 95% CI (0.39, 2.70). CONCLUSIONS The results of this study indicate that 1 mg varenicline BID was not an effective treatment for MA dependence among treatment-seeking MA-dependent volunteers.
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Affiliation(s)
- Marisa Briones
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Steven Shoptaw
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ryan Cook
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Matthew Worley
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Aimee-Noelle Swanson
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - David E. Moody
- Center for Human Toxicology, Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT, USA
| | - Wenfang B. Fang
- Center for Human Toxicology, Department of Pharmacology and Toxicology, University of Utah, Salt Lake City, UT, USA
| | - John Tsuang
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Benjamin Furst
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Keith Heinzerling
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Davies NM, Taylor GMJ, Taylor AE, Jones T, Martin RM, Munafò MR, Windmeijer F, Thomas KH. The effects of prescribing varenicline on two-year health outcomes: an observational cohort study using electronic medical records. Addiction 2018; 113:1105-1116. [PMID: 29460494 PMCID: PMC5969097 DOI: 10.1111/add.14146] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/23/2017] [Accepted: 12/19/2017] [Indexed: 11/29/2022]
Abstract
AIMS To investigate whether smokers prescribed varenicline had lower risks of serious ill-health during the 4 years following treatment compared with those prescribed nicotine replacement therapy (NRT). DESIGN Observational cohort study of electronic medical records. SETTING A total of 370 UK general practices sampled from the Clinical Practice Research Datalink. PARTICIPANTS A total of 126 718 patients aged 18 and over who were issued smoking cessation prescriptions between 1 September 2006 and 31 March 2014. MEASUREMENTS Our primary outcome was all-cause mortality within 2 years of first prescription as indicated by linked Office of National Statistics data. Our secondary outcomes were cause-specific mortality, all-cause, cause-specific hospitalization, primary care diagnosis of myocardial infarction or chronic obstructive pulmonary disease (COPD), body mass index and attendance rate to primary care within 2 years of first prescription. Risk differences and 95% confidence intervals were estimated by multivariable adjusted regression and propensity score matched regression. We used instrumental variable analysis to overcome residual confounding. FINDINGS People prescribed varenicline were healthier at baseline than those prescribed NRT in almost all characteristics, highlighting the potential for residual confounding. Our instrumental variable analysis results found that people prescribed varenicline had a similar risk of mortality at 2 years [risk difference per 100 patients treated = 0.67, 95% confidence interval (CI) = -0.11 to 1.46)] to those prescribed NRT, and there were similar rates of all-cause hospitalization, incident primary-care diagnoses of myocardial infarction and COPD. People prescribed varenicline subsequently attended primary care less frequently. CONCLUSIONS Smokers prescribed varenicline in primary care in the United Kingdom do not appear to be less likely to die, be hospitalized or experience a myocardial infarction or chronic obstructive pulmonary disease during the following 2 years compared with smokers prescribed nicotine replacement therapy, but they gain more weight and attend primary care less frequently.
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Affiliation(s)
- Neil M. Davies
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK
| | - Gemma M. J. Taylor
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- UK Centre for Tobacco and Alcohol Studies, School of Experimental PsychologyUniversity of BristolBristolUK
| | - Amy E. Taylor
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- UK Centre for Tobacco and Alcohol Studies, School of Experimental PsychologyUniversity of BristolBristolUK
| | - Timothy Jones
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West)University Hospitals Bristol NHS Foundation TrustBristolUK
| | - Richard M. Martin
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West)University Hospitals Bristol NHS Foundation TrustBristolUK
| | - Marcus R. Munafò
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- UK Centre for Tobacco and Alcohol Studies, School of Experimental PsychologyUniversity of BristolBristolUK
| | - Frank Windmeijer
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Department of EconomicsUniversity of BristolBristolUK
| | - Kyla H. Thomas
- Bristol Medical School, Population Health SciencesUniversity of BristolBristolUK
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Gershon AS, Campitelli MA, Hawken S, Victor C, Sproule BA, Kurdyak P, Selby P. Cardiovascular and Neuropsychiatric Events after Varenicline Use for Smoking Cessation. Am J Respir Crit Care Med 2018; 197:913-922. [DOI: 10.1164/rccm.201706-1204oc] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andrea S. Gershon
- Department of Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Medicine
- Hospital for Sick Children, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and
| | | | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Charles Victor
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Beth A. Sproule
- Leslie Dan Faculty of Pharmacy
- Department of Psychiatry
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and
| | - Paul Kurdyak
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Psychiatry
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and
| | - Peter Selby
- Department of Psychiatry
- Department of Family and Community Medicine
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada
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Efficacy and safety of varenicline for smoking cessation in people living with HIV in France (ANRS 144 Inter-ACTIV): a randomised controlled phase 3 clinical trial. Lancet HIV 2018; 5:e126-e135. [PMID: 29329763 DOI: 10.1016/s2352-3018(18)30002-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/23/2017] [Accepted: 11/07/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tobacco smoking is common in people living with HIV, but high-quality evidence on interventions for smoking cessation is not available in this population. We aimed to assess the efficacy and safety of varenicline with counselling to aid smoking cessation in people living with HIV. METHODS The ANRS 144 Inter-ACTIV randomised, parallel, double-blind, multicentre, placebo-controlled phase 3 trial was done at 30 clinical hospital sites in France. People living with HIV who had smoked at least ten cigarettes per day for 1 year or longer, were motivated to stop smoking, were not dependent on another psychoactive substance, and had no history of depression or suicide attempt were eligible. Using a computer-generated randomisation sequence, we allocated (1:1) the patients to receive either varenicline titrated to two 0·5 mg doses twice daily or placebo twice daily for 12 weeks, plus face-to-face counselling. Patients and investigators were masked to treatment group allocation. Patients who were not abstinent at week 24 were offered open-label varenicline for 12 additional weeks. The primary outcome was the proportion of smokers continuously abstinent from week 9 to week 48. Smoking status was confirmed by carbon monoxide in exhaled air. Primary analyses were done in both the intention-to-treat (ITT) population and modified ITT (mITT) population, which comprised all patients who took at least one tablet of their assigned study treatment. The safety analyses were done in the mITT population. The trial is registered at ClinicalTrials.gov, number NCT00918307. The trial status is complete. FINDINGS From Oct 26, 2009, to Dec 20, 2012, of 303 patients assessed for eligibility, 248 patients were randomly assigned to the varenicline group (n=123) or the placebo group (n=125). After randomisation, one participant initially assigned to the placebo group was excluded from the ITT analysis for a regulatory reason (no French health-care coverage). 102 patients in the varenicline group and 111 patients in the placebo group received at least one dose of their assigned treatment and were included in the mITT analysis. In the ITT analysis, varenicline was associated with a higher proportion of patients achieving continuous abstinence over the study period (week 9-48): 18 (15%, 95% CI 8-21) of 123 in the varenicline group versus eight (6%, 2-11) of 124 in the placebo group, adjusted odds ratio (OR) 2·5 (95% CI 1·0-6·1; p=0·041). In the mITT analysis, varenicline was also associated with higher continuous abstinence: 18 (18%, 95% CI 10-25) of 102 versus eight (7%, 2-12) of 111 in the placebo group (adjusted OR 2·7, 95% CI 1·1-6·5; p=0·029). The incidence of depression was 2·4 per 100 person-years (95% CI 0·6-9·5; two [2%] of 102) in the varenicline group and 12·4 per 100 person-years (95% CI 6·9-22·5; 11 [10%] of 111) in the placebo group. 14 (7%) of 213 participants had 18 cardiovascular events: six (6%) of 102 people in the varenicline group and eight (7%) of 111 people in the placebo group. INTERPRETATION Varenicline is safe and efficacious for smoking cessation in people living with HIV and should be recommended as the standard of care. FUNDING The French National Institute for Health and Medical Research (INSERM)-French National Agency for Research on AIDS and Viral Hepatitis (ANRS) and Pfizer.
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