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Bellini BB, Scholz JR, Abe TO, Arnaut D, Tonstad S, Alberto RL, Gaya PV, de Moraes IRA, Teixeira MJ, Marcolin MA. Does deep TMS really works for smoking cessation? A prospective, double blind, randomized, sham controlled study. Prog Neuropsychopharmacol Biol Psychiatry 2024; 132:110997. [PMID: 38531486 DOI: 10.1016/j.pnpbp.2024.110997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/27/2024] [Accepted: 03/23/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION A substantial proportion of smokers wishing to quit do not stop smoking when using current therapies to aid cessation. Magnetic pulses to specific brain areas designated as transcranial magnetic stimulation may modulate brain activity and thereby change chemical dependencies. Deep transcranial magnetic stimulation (dTMS) with the H4 coil stimulates neuronal pathways in the lateral prefrontal cortex and insula bilaterally, areas involved in tobacco addiction. OBJECTIVE To evaluate the efficacy and safety of dTMS with T4 coil in smoking cessation. METHODS In a double blind, controlled clinical trial, adult smokers of at least 10 cigarettes/day were randomized to active (n = 50) versus sham dTMS (n = 50). The protocol involved up to 21 sessions administered over up to 12 weeks. Tobacco use was monitored by self-report and confirmed by expired air monoximetry (at each dTMS visit) and blood cotinine (at the screening visit and at the end of sessions). Participants completed abstinence, mood and cognition scales at determined timepoints during follow-up. RESULTS In the intention to-treat-analysis, the cessation rate of the intervention and control groups was 14.0%. The reported side effects were as expected for this procedure. Although there were no serious adverse events, three participants were withdrawn according to safety criteria. CONCLUSION Active treatment with dTMS H4 coil was safe but not effective for smoking cessation.
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Affiliation(s)
- Bianca B Bellini
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil; Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil.
| | - Jaqueline R Scholz
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Tania O Abe
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Debora Arnaut
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Serena Tonstad
- Department of Preventive Cardiology, Oslo University Hospital, Oslo, Norway
| | - Rodrigo L Alberto
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Patricia V Gaya
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Iana R A de Moraes
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Manoel J Teixeira
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Marco A Marcolin
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
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Gaya PV, Santos JR, Tomaz PRX, Abe TMO, Nassif M, Galas LG, Bellini BB, Moraes IR, Santos PCL, Correa PCRP, Scholz JR. Efficacy of bupropion and varenicline genetic markers in choosing pharmacological treatment for smoking cessation, and implications for combining drugs: A randomized controlled trial - GENTSMOKING. Tob Induc Dis 2024; 22:TID-22-62. [PMID: 38628555 PMCID: PMC11019925 DOI: 10.18332/tid/186072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/09/2024] [Accepted: 03/14/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Smoking cessation is the best strategy for reducing tobacco-related morbimortality. The goal of this randomized controlled trial was to test whether using the genetically favorable markers to choose a smoking cessation drug treatment (precision medicine) was superior to using the most effective drug (varenicline) in terms of abstinence rates. Additionally, combination therapy was tested when monotherapy failed. METHODS This partially blind, single-center study randomized (1:1) 361 participants into two major groups. In the genetic group (n=184), CYP2B6 rs2279343 (genotype AA) participants started treatment with bupropion, and CHRNA4 rs1044396 (genotype CT or TT) participants started treatment with varenicline; when genetic favorable to both, participants started treatment with bupropion, and when favorable to neither, on both drugs. In the control group (n=177), participants started treatment with varenicline, regardless of genetic markers. Drug treatment lasted 12 weeks. Efficacy endpoints were abstinence rates at Weeks 4, and Weeks 8-12, biochemically validated by carbon monoxide in exhaled air. Participants who did not achieve complete abstinence at Week 4, regardless of group, were given the choice to receive combination therapy. RESULTS Abstinence rates were 42.9% (95% CI: 36-64) in the control group versus 30.4% (95% CI: 23-37) in the genetic group at Week 4 (p=0.01); and 74% (95% CI: 67-80) versus 52% (95% CI: 49-64) at Week 12 (p<0.001), respectively. The strategy of combining drugs after Week 4 increased abstinence rates in both groups and the significant difference between genetic and control groups was maintained. CONCLUSIONS Results show that using these selected genetic markers was inferior to starting treatment with varenicline (control group), which is currently the most effective smoking cessation drug; moreover, the addition of bupropion in cases of varenicline monotherapy failure improves the efficacy rate until the end of treatment. CLINICAL TRIAL IDENTIFIER NCT03362099.
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Affiliation(s)
- Patricia V. Gaya
- Programa de Tratamento do Tabagismo do Servico de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Juliana R. Santos
- Laboratorio de Genetica e Biologia Molecular, Instituto do Coracao, Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo R. X. Tomaz
- Laboratorio de Genetica e Biologia Molecular, Instituto do Coracao, Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Tania M. O. Abe
- Programa de Tratamento do Tabagismo do Servico de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Miguel Nassif
- Programa de Tratamento do Tabagismo do Servico de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Larissa G. Galas
- Programa de Tratamento do Tabagismo do Servico de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bianca B. Bellini
- Programa de Tratamento do Tabagismo do Servico de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Iana R. Moraes
- Programa de Tratamento do Tabagismo do Servico de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo C. Lima Santos
- Departamento de Farmacologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Jaqueline R. Scholz
- Programa de Tratamento do Tabagismo do Servico de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Scholz JR, Malta DC, Fagundes Júnior AADP, Pavanello R, Bredt Júnior GL, Rocha MDS. Brazilian Society of Cardiology Position Statement on the Use of Electronic Nicotine Delivery Systems - 2024. Arq Bras Cardiol 2024; 121:e20240063. [PMID: 38422228 DOI: 10.36660/abc.20240063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Affiliation(s)
- Jaqueline R Scholz
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), SP - Brasil
| | | | - Antonio Aurélio de Paiva Fagundes Júnior
- Instituto D'Or de Pesquisa e Ensino (IDOR), Brasília, DF - Brasil
- Universidade de Brasília (UNB), Brasília, DF - Brasil
- Hospital DFStar, RedeDO'r, Brasília, DF - Brasil
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Scholz JR, Abe TO, Gaya PV, Bellini B, de Moraes IRA, Santos JR, Tomaz PRX, de Lima Santos PC, Tonstad S. Cue restricted smoking increases quit rates with varenicline. Tob Prev Cessat 2021; 7:33. [PMID: 34017927 PMCID: PMC8114580 DOI: 10.18332/tpc/133570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Varenicline effectively helps smokers quit by reducing withdrawal symptoms and blocking the reward of smoking. However, most quitters return to smoking within one year. ‘Cue Restricted Smoking’ is a behavioral technique designed to increase quit rates by asking smokers attempting to quit to restrict smoking to the standing position, while alone, in an isolated area facing a wall, with the cigarette as the only stimulus. METHODS Using retrospective clinic records we compared quit rates in 281 smokers (50% males) instructed in the cue restricted smoking cessation method during 2016–2018 to quit rates in 324 smokers (46% males) advised to completely stop smoking on the target quit date which we previously used during 2011–2014. All were prescribed varenicline for 12 weeks alone, with the addition of bupropion if needed after 4 weeks. Follow-up consisted of behavioral support at 4–6 visits during active drug treatment and telephone counselling at 24 and 52 weeks. The smoking cessation rate was confirmed with exhaled carbon monoxide at the clinic visit at 12 weeks and only by telephone at 52 weeks. RESULTS The mean age of smokers was 49 years in both groups and the number of cigarettes smoked daily was similar (18/day in the cue restricted vs 19/day in the target quit day group). The smoking cessation rate at 12 weeks was 75% in the cue restricted versus 45% in the target quit day group (relative risk, RR=1.8; 95% CI: 1.4–2.2, p<0.001). At 52 weeks the quit rate was 65% vs 34%, respectively (RR=1.9; 95% CI: 1.5–2.4, p<0.001). CONCLUSIONS Cue restricted smoking was associated with a substantially increased chance of quitting compared with standard advice during treatment with varenicline. These results should be further studied in a randomized controlled trial.
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Affiliation(s)
- Jaqueline R Scholz
- Department of Preventive Medicine, Heart Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Tania O Abe
- Department of Preventive Medicine, Heart Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Patricia V Gaya
- Department of Preventive Medicine, Heart Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Bianca Bellini
- Department of Preventive Medicine, Heart Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Iana R A de Moraes
- Department of Preventive Medicine, Heart Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Juliana R Santos
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo R X Tomaz
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo C de Lima Santos
- Department of Pharmacology, Paulista School of Medicine, Federal University of Sao Paolo, Sao Paulo, Brazil
| | - Serena Tonstad
- Department of Preventive Cardiology, Oslo University Hospital, Oslo, Norway
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Cruz BS, Schwarzmeier L, Carvalho B, Alves M, Carta C, Balducci I, Scholz JR, Almeida JD. Association between DNA ploidy and micronucleus frequency in chronic smokers and impact of smoking cessation. Hum Exp Toxicol 2021; 40:1374-1382. [PMID: 33541126 DOI: 10.1177/0960327121991904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Tobacco use may initiate the process of oral carcinogenesis with clinically undetectable changes. Smoking cessation may prevent its progression. The objective of this study was to evaluate the association between DNA ploidy and micronucleus (MN) frequency in chronic smokers. Three groups were evaluated: Smoker Group, Former Smoker Group and Control Group. Exfoliative cytology was performed on the lateral border of the tongue and mouth floor. MN and DNA ploidy analyses were performed, as well as the correlation between the variables. The data showed a difference between the groups for the total MN (p = 0.0227), and the Smoker group had the highest mean (4.22 ± 4.12). The three groups did not differ statistically from each other on ploidy evaluation (p-value > 0.05). There was also an association between aneuploidy and increased MN frequency in the Former Smoker group (p = 0.0036). In conclusion, these results point out that there is a relationship between the frequency of MN and aneuploidy in former smokers. Moreover, smoking cessation, even for a short period of time, may promote the decrease of MN frequency caused by tobacco use.
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Affiliation(s)
- B S Cruz
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University 28108(Unesp), São José dos Campos, São Paulo, Brazil
| | - Lat Schwarzmeier
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University 28108(Unesp), São José dos Campos, São Paulo, Brazil
| | - Bfdc Carvalho
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University 28108(Unesp), São José dos Campos, São Paulo, Brazil
| | - Mgo Alves
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University 28108(Unesp), São José dos Campos, São Paulo, Brazil.,Universidade Anhembi Morumbi, São José dos Campos, São Paulo, Brazil.,Universidade Mogi das Cruzes, Mogi das Cruzes, São Paulo, Brazil
| | - Cfl Carta
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University 28108(Unesp), São José dos Campos, São Paulo, Brazil
| | - I Balducci
- Department of Social Science and Pediatric Dentistry, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil
| | - J R Scholz
- Heart Institute, University Hospital, Medical School, 42523University of São Paulo, São Paulo, Brazil
| | - J D Almeida
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University 28108(Unesp), São José dos Campos, São Paulo, Brazil
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