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Zhang X, Sun Y, Cheung YTD, Wang MP, Wu YS, Chak KY, Chen J, Leung LT, Lam TH, Ho SY. Cigarettes, heated tobacco products and dual use: exhaled carbon monoxide, saliva cotinine and total tobacco consumed by Hong Kong tobacco users. Tob Control 2024; 33:457-463. [PMID: 36693724 DOI: 10.1136/tc-2022-057598] [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: 07/04/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Independent studies on exhaled carbon monoxide (CO) and saliva cotinine levels in regular heated tobacco product (HTP) users, and how they compare with conventional cigarette (CC) smokers, are lacking. METHODS A total of 3294 current users of CCs, HTPs or electronic cigarettes (ECs) from a household survey and a smoking hotspot survey were classified into seven groups: exclusive users of CCs, HTPs, ECs; dual users of CCs and HTPs, CCs and ECs, HTPs and ECs; and triple users. We measured exhaled CO level using the piCo Smokerlyzer (n=780) and saliva cotinine using NicAlert cotinine test strips (n=620). Among the seven groups, the differences in (1) CO and cotinine levels were examined using Kruskal-Wallis test, and (2) the average daily tobacco consumption in the past 30 days was examined using multivariable linear regression. RESULTS Both exclusive and dual users of CCs had a higher CO level than exclusive HTP or EC users (p<0.05). Exhaled CO levels were similar between HTP and EC users, as were saliva cotinine levels among the seven groups. Compared with exclusive CC users, those who also used HTPs or ECs smoked fewer CCs (CCs+HTPs: adjusted coefficient -2.79, 95% CI -3.90 to -1.69; CCs+ECs: -1.34, 95% CI -2.34 to -0.34), but consumed more tobacco sticks equivalent in total (2.79 (95% CI 1.61 to 3.96); 1.95 (95% CI 0.79 to 3.12)). CONCLUSIONS HTP or EC use showed lower exhaled CO but similar saliva cotinine levels compared with CC use. Dual users of CCs and HTPs/ECs smoked fewer CCs than exclusive CC users, but consumed more tobacco in total.
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Affiliation(s)
- Xiaoyu Zhang
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Yuying Sun
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Yee Tak Derek Cheung
- School of Nursing, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Yongda Socrates Wu
- School of Nursing, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Kin Yeung Chak
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Jianjiu Chen
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Lok Tung Leung
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong SAR, People's Republic of China
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Ardati O, Adeniji A, El Hage R, Salman R, El-Kaassamani M, Yassine A, Talih S, Hourani M, Karaoghlanian N, Breland A, Eissenberg T, Saliba N, Shihadeh A, El-Hellani A. Impact of smoking intensity and device cleaning on IQOS emissions: comparison with an array of cigarettes. Tob Control 2024; 33:449-456. [PMID: 36609493 PMCID: PMC10323035 DOI: 10.1136/tc-2022-057802] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/26/2022] [Indexed: 01/09/2023]
Abstract
SIGNIFICANCE IQOS is a heated tobacco product that has been widely advertised by Philip Morris International (PMI) as a reduced-exposure product compared with cigarettes. Reduced exposure results from reduced emission of toxicants which could be influenced by product constituents and user behaviour. This study aims to assess the influence of user behaviour, including device cleaning and puffing parameters, on toxicant emissions from IQOS. METHODS IQOS aerosols were generated by a smoking machine using the combination of two cleaning protocols (after 1 stick vs 20 sticks) and five puffing regimes (including standard cigarette puffing regimes and IQOS-tailored regimes). The generated aerosols were analysed by targeted methods for phenol and carbonyl quantification, and by chemical screening for the identification of unknown compounds. RESULTS Puffing parameters significantly affected phenol and carbonyl emissions while device cleaning had no effect. Harsher puffing conditions like more, longer, and larger puffs yielded higher levels for most toxicant emissions. Comparing the obtained data with data reported by PMI on 50 cigarette brands smoked under different puffing regimes showed various trends for phenol and carbonyl emissions, with IQOS emissions sometimes higher than cigarettes. Also, the chemical screening resulted in the tentative identification of ~100 compounds in the IQOS aerosols (most of limited toxicity data). CONCLUSION This study showed that puffing parameters, but not device cleaning, have significant effects on carbonyl, phenol and other emissions. Data analysis highlighted the importance of comparing IQOS emissions with an array of commercial cigarettes tested under different puffing regimes before accepting reduced exposure claims.
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Affiliation(s)
- Ola Ardati
- Department of Chemistry, American University of Beirut Faculty of Arts and Sciences, Beirut, Lebanon
| | - Ayomipo Adeniji
- Division of Environmental Health Sciences, The Ohio State University College of Public Health, Columbus, Ohio, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Rachel El Hage
- Department of Chemistry, American University of Beirut Faculty of Arts and Sciences, Beirut, Lebanon
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rola Salman
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Malak El-Kaassamani
- Department of Physical and Environmental Sciences, University of Toronto Faculty of Arts & Science, Toronto, Ontario, Canada
| | - Amira Yassine
- Department of Environmental Health and Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland, USA
| | - Soha Talih
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Mario Hourani
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Nareg Karaoghlanian
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Alison Breland
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Najat Saliba
- Department of Chemistry, American University of Beirut Faculty of Arts and Sciences, Beirut, Lebanon
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Alan Shihadeh
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
| | - Ahmad El-Hellani
- Division of Environmental Health Sciences, The Ohio State University College of Public Health, Columbus, Ohio, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
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Ghazi S, Song MA, El-Hellani A. A scoping review of the toxicity and health impact of IQOS. Tob Induc Dis 2024; 22:TID-22-97. [PMID: 38832049 PMCID: PMC11145630 DOI: 10.18332/tid/188867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 05/14/2024] [Accepted: 05/18/2024] [Indexed: 06/05/2024] Open
Abstract
This work aims to summarize the current evidence on the toxicity and health impact of IQOS, taking into consideration the data source. On 1 June 2022, we searched PubMed, Web of Science, and Scopus databases using the terms: 'heated tobacco product', 'heat-not-burn', 'IQOS', and 'tobacco heating system'. The search was time-restricted to update a previous search conducted on 8 November 2021, on IQOS data from 2010-2021. The data source [independent, Philip Morris International (PMI), or other manufacturers] was retrieved from relevant sections of each publication. Publications were categorized into two general categories: 1) Toxicity assessments included in vitro, in vivo, and systems toxicology studies; and 2) The impact on human health included clinical studies assessing biomarkers of exposure and biomarkers of health effects. Generally, independent studies used classical in vitro and in vivo approaches, but PMI studies combined these with modeling of gene expression (i.e. systems toxicology). Toxicity assessment and health impact studies covered pulmonary, cardiovascular, and other systemic toxicity. PMI studies overall showed reduced toxicity and health risks of IQOS compared to cigarettes, but independent data did not always conform with this conclusion. This review highlights some discrepancies in IQOS risk assessment regarding methods, depth, and breadth of data collection, as well as conclusions based on the data source.
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Affiliation(s)
- Sarah Ghazi
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus OH, United States
| | - Min-Ae Song
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus OH, United States
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus OH, United States
| | - Ahmad El-Hellani
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus OH, United States
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus OH, United States
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Braznell S, Van Den Akker A, Metcalfe C, Taylor GMJ, Hartmann-Boyce J. Critical appraisal of interventional clinical trials assessing heated tobacco products: a systematic review. Tob Control 2024; 33:383-394. [PMID: 36347620 DOI: 10.1136/tc-2022-057522] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To critically assess the methodological characteristics and quality of interventional clinical trials investigating the effects of heated tobacco products (HTPs). DATA SOURCES Web of Science (Core collection and MEDLINE), Scopus, MedRxiv, ClinicalTrials.gov and ICTRP trial databases and transnational HTP manufacturer online publication libraries were searched for clinical trials on HTPs published between January 2010 and April 2022. STUDY SELECTION Interventional clinical trials of any design, in which at least one group of adult participants used a currently marketed HTP, were selected by two reviewers with good or very good agreement. DATA EXTRACTION Data relating to trial characteristics and effects of intervention on primary outcomes were extracted using a predesigned form. Risk of bias was assessed using Cochrane's Risk of Bias tool v1. DATA SYNTHESIS 40 trials were included, 29 of which were tobacco industry affiliated. Methodological characteristics, such as registration, design, setting, comparator interventions, participants, outcomes and analyses, varied between trials, though there were few significant differences between industry-affiliated and independent trials. Of the 40 trials, 33 were judged to be at high risk of bias and 6 at unclear risk of bias. Trial findings were not significantly associated with either affiliation or risk of bias. CONCLUSIONS The conduct and reporting of HTP interventional clinical trials were poor in many respects and limited to investigating effects of short-term exposure. These trials fall short of what is needed to determine whether HTPs are beneficial to public health, meaning they may not be a sound basis for tobacco control policy decisions.
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Affiliation(s)
| | | | - Chris Metcalfe
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Gemma M J Taylor
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, UK
| | - Jamie Hartmann-Boyce
- Centre for Evidence-Based Medicine, University of Oxford Division of Public Health and Primary Health Care, Oxford, UK
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Kale D, Brown J, Dawkins L, Goniewicz ML, Leppin C, Tattan-Birch H, Shahab L. Comparing identity, attitudes, and indicators of effectiveness in people who smoke, vape or use heated tobacco products: A cross-sectional study. Addict Behav 2024; 151:107933. [PMID: 38142579 DOI: 10.1016/j.addbeh.2023.107933] [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: 08/04/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND There is limited long-term and independent research on heated tobacco products (HTPs). We compared people who used HTPs with those who used nicotine vaping products (NVP) or cigarettes on smoker identity, indicators of effectiveness and, among NVP/HTP users, perceptions of these products. METHODS Adults exclusive cigarette smokers (N = 45) and ex-smokers with medium/long-term (>3months) NVP (N = 46) or HTP use (N = 45) were recruited in London, UK. Participants completed a questionnaire assessing socio-demographics, smoking characteristics, smoker identity, dependence, intention to stop and attitudes towards HTP/NVP. RESULTS In adjusted analysis, people who used cigarettes (Mean Difference (MD) = 1.4, 95%Confidence Intervals (CI) 0.7,2.0) and HTPs (MD = 0.8, 95%CI 0.1, 1.5) reported stronger smoker identities than those who used NVPs. Compared with smokers, HTP/NVP users had lower cravings for cigarettes (MD = 3.0, 95%CI 1.6, 4.3; MD = 3.1, 95%CI 1.9, 4.3, respectively), and higher intention to stop product use (MD = -0.8, 95%CI -1.7,-0.01; MD = -1.2, 95%CI -2.0, -0.3, respectively). People using HTPs or NVPs reported similar perceived product satisfaction (HTP:M = 3.4, 95%CI 2.8, 3.9; NVP:M = 3.0, 95%CI 2.5, 3.5), efficacy for smoking cessation (HTP:M = 4.5, 95%CI 4.2, 4.9; NVP:M = 4.6, 95%CI 4.3, 4.9) and safety (HTP:M = 2.1, 95%CI 2.0, 2.2; NVP:M = 2.0, 95%CI 1.8, 2.1). HTP users reported greater perceived addictiveness than NVPs (MD = 0.3, 95%CI 0.2, 0.6). CONCLUSIONS HTP and NVP users perceived products to be similarly acceptable and effective suggesting that HTPs, like NVPs, may support smoking cessation. However, since HTP use appears to maintain a stronger smoker identity and perceived addiction, this may suggest a more limited role of HTP for a permanent transition away from cigarettes.
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Affiliation(s)
- Dimitra Kale
- Department of Behavioural Science and Health, University College London, UK; SPECTRUM Consortium, UK.
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, UK; SPECTRUM Consortium, UK
| | - Lynne Dawkins
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, UK
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Corinna Leppin
- Department of Behavioural Science and Health, University College London, UK; SPECTRUM Consortium, UK
| | - Harry Tattan-Birch
- Department of Behavioural Science and Health, University College London, UK; SPECTRUM Consortium, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, UK; SPECTRUM Consortium, UK
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Polosa R, Pluym N, Scherer M, Belsey J, Russell C, Caponnetto P, Weglarz J, Campagna D. Protocol for the "magnitude of cigarette substitution after initiation of e-cigarettes and its impact on biomarkers of exposure and potential harm in dual users" (MAGNIFICAT) study. Front Public Health 2024; 12:1348389. [PMID: 38584934 PMCID: PMC10996441 DOI: 10.3389/fpubh.2024.1348389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/08/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Many smokers who use e-cigarettes (ECs) to quit continue smoking alongside vaping. The impact on health among individuals who simultaneously smoke conventional cigarettes (CCs) and use ECs remains unclear. The varying patterns of dual use present differing levels of overall toxin exposure and relative risks concerning smoking-related diseases. Understanding these complexities is vital to assessing the implications for human health. Objective Herein we describe a protocol designed to analyze the impact of different level of substituting CCs with ECs on exposure to toxicants. We'll use biomarkers to measure this exposure and assess harm reduction in dual users through clinical endpoints, harm-related biomarkers, and behavioral correlations. We expect to observe progressive changes with varying patterns of dual use. Methods and analyses For this purpose, we planned to recruit a group of 250 smokers who will be asked to reduce their CC consumption by adopting ECs (intervention group). A separate group of 50 smokers will continue to smoke CC (reference group). Study groups will be followed up for 6 months during which biospecimens will be collected for biomarker analyses, and clinical endpoints will be assessed. The trial is structured to characterize subjects' usage patterns over time using robust biomarkers of exposure and a standardized mobile phone application to facilitate the precise categorization of dual users along the risk continuum based on their usage behaviors. Subject recruitment will start in February 2024 and enrolment is expected to be completed by August 2024. Results will be reported early in 2025. Study findings may provide valuable insights into health benefits or risks associated with varying patterns of dual use. Ethics and dissemination The study protocol and informed consent forms will be approved by the local Ethical Review Boards. Study results will be disseminated through articles published in reputable, peer-reviewed, open access, scientific journals, presentations at conferences, and the University website.
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Affiliation(s)
- Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), University Teaching Hospital "Policlinico-S.Marco", University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy
| | - Nikola Pluym
- ABF Analytisch-Biologisches Forschungslabor GmbH, Planegg, Germany
| | - Max Scherer
- ABF Analytisch-Biologisches Forschungslabor GmbH, Planegg, Germany
| | | | | | - Pasquale Caponnetto
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, Catania, Italy
- Department of Science of Education, Section of Psychology, University of Catania, Catania, Italy
| | - Jakub Weglarz
- ECLAT Srl, Spin-off of the University of Catania, Catania, Italy
| | - Davide Campagna
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- UOC MCAU, University Teaching Hospital "Policlinico-S.Marco", University of Catania, Catania, Italy
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Krysiński A, Russo C, Campagna D, Di Pino A, John S, Belsey J, Caponnetto P, Vudu L, Lim CW, Di Ciaula A, Veronese N, Barbagallo M, Iqbal F, Fluck D, Franek E, Polosa R, Sharma P. A multicenter prospective randomized controlled trial investigating the effects of combustion-free nicotine alternatives on cardiovascular risk factors and metabolic parameters in individuals with type 2 diabetes who smoke: the DiaSmokeFree study protocol. Intern Emerg Med 2024; 19:321-332. [PMID: 37999870 PMCID: PMC10954907 DOI: 10.1007/s11739-023-03467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/16/2023] [Indexed: 11/25/2023]
Abstract
Stopping smoking is crucial for public health and especially for individuals with diabetes. Combustion-free nicotine alternatives like e-cigarettes and heated tobacco products are increasingly being used as substitutes for conventional cigarettes, contributing to the decline in smoking prevalence. However, there is limited information about the long-term health impact of those products in patients with diabetes. This randomized controlled trial aims to investigate whether switching from conventional cigarettes to combustion-free nicotine alternatives will lead to a measurable improvement in cardiovascular risk factors and metabolic parameters over a period of 2 years in smokers with type 2 diabetes. The multicenter study will be conducted in seven sites across four countries. A total of 576 smokers with type 2 diabetes will be randomly assigned (1:2 ratio) to either standard of care with brief cessation advice (Control Arm) or combustion-free nicotine alternatives use (Intervention Arm). The primary end point is the change in the proportion of patients with metabolic syndrome between baseline and the 2-year follow-up. Additionally, the study will analyze the absolute change in the sum of the individual factors of metabolic syndrome at each study time point. Patient recruitment has started in September 2021 and enrollment is expected to be completed by December 2023. Results will be reported in 2026. This study may provide valuable insights into cardiovascular and metabolic health benefits or risks associated with using combustion-free nicotine alternatives for individuals with type 2 diabetes who are seeking alternatives to tobacco cigarette smoking. The study protocol, informed consent forms, and relevant documents were approved by seven ethical review boards. Study results will be disseminated through articles published in high-quality, peer-reviewed journals and presentations at conferences.
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Affiliation(s)
- Arkadiusz Krysiński
- Polish Academy of Sciences, Mossakowski Medical Research Centre Polish-Academy of Sciences, Warsaw, Poland.
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital, PIM MSWiA, Warsaw, Poland.
| | - Cristina Russo
- Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
| | - Davide Campagna
- Emergency Department, Teaching Hospital Policlinico "G. Rodolico-San Marco" of Catania, University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Antonino Di Pino
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Sarah John
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Pasquale Caponnetto
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
- Department of Educational Sciences, Section of Psychology, University of Catania, Catania, Italy
| | - Lorina Vudu
- Nicolae Testemitanu State Medical and Pharmaceutical University, Chisinau, Republic of Moldova
| | - Chong Wei Lim
- Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
| | - Agostino Di Ciaula
- Division of Internal Medicine, Department of Preventive and Regenerative Medicine and Ionian Area (DiMePrev-J), Clinica Medica "A. Murri", University of Bari Aldo Moro, Bari, Italy
| | - Nicola Veronese
- Geriatrics Section, Department of Medicine, University of Palermo, Palermo, Italy
| | - Mario Barbagallo
- Geriatrics Section, Department of Medicine, University of Palermo, Palermo, Italy
| | - Farrukh Iqbal
- The University of Lahore University College of Medicine and Dentistry, Lahore, Pakistan
| | - David Fluck
- Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
| | - Edward Franek
- Polish Academy of Sciences, Mossakowski Medical Research Centre Polish-Academy of Sciences, Warsaw, Poland
- Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital, PIM MSWiA, Warsaw, Poland
| | - Riccardo Polosa
- Center of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pankaj Sharma
- Ashford and Saint Peter's Hospitals NHS Trust, Chertsey, UK
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8
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Conte G, Pacino SA, Urso S, Greiling D, Caponnetto P, Pedullà E, Generali L, Consolo U, Checchi V, Gospodaru S, Bordeniuc G, Fala V, Kowalski J, Nowak M, Górska R, Amaliya A, Chapple I, Milward M, Maclure R, Nardi GM, Polosa R. Changes in Oral Health and Dental Esthetic in Smokers Switching to Combustion-Free Nicotine Alternatives: Protocol for a Multicenter and Prospective Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e53222. [PMID: 38393754 PMCID: PMC10924261 DOI: 10.2196/53222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Although the detrimental effects of conventional combustible cigarettes on oral health and dental esthetics are well known, there is limited information about the long-term impact of combustion-free nicotine alternatives (C-F NA) such as e-cigarettes or heated tobacco products. OBJECTIVE This multicenter, prospective, 3-parallel-arm randomized controlled trial will investigate whether switching from combustible cigarettes to C-F NA will lead to measurable improvements in oral health parameters and dental esthetics over 18 months in adult smokers with limited gum disease. METHODS Regular smokers not intending to quit and without clinical signs of periodontitis will be randomly assigned (1:4 ratio) to either standard of care with brief cessation advice (control group; arm A) or C-F NA use (intervention group; arm B). The study will also include a reference group of never smokers (reference group; arm C). The primary end point is the change in the Modified Gingival Index (MGI) score from baseline between the control arm (arm A) and the intervention arm (arm B) at the 18-month follow-up. In addition, the study will analyze the within- and between-group (arms A, B, and C) changes in MGI assessment, plaque imaging, dental shade quantitation, tooth stain scores, and oral health-related quality of life questionnaires measured at each study time point. All participants will attend a total of 7 clinic visits: screening, enrollment, and randomization (visit 0); baseline visit-day 14 (visit 1); day 90 (visit 2); day 180 (visit 3); day 360 (visit 4); and day 540 (visit 5). This multicenter study will be conducted in 4 dental clinics in 4 countries. The statistical analysis will involve descriptive statistics for continuous and categorical data. Primary end points will undergo tests for normality and, based on distribution, either a 2-sided t test or Mann-Whitney U test. Linear mixed model with random factors center and study arms by center will also be applied. Secondary end points, including MGI assessment and quality of life, will be subjected to similar tests and comparisons. Only if one value of the parameter MGI is missing after day 1, the last available observation will be carried forward. The analysis will be performed on the substituted data. Secondary parameters will not have missing value replacement. RESULTS Participant recruitment began in October 2021, and enrollment was completed in June 2023. Results will be reported in 2025. CONCLUSIONS This will be the first study to provide key insights into oral health benefits or risks associated with using C-F NA in smokers who are seeking alternatives to cigarette smoking. TRIAL REGISTRATION ClinicalTrials.gov NCT04649645; https://clinicaltrials.gov/ct2/show/NCT04649645. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53222.
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Affiliation(s)
| | - Sebastiano Antonio Pacino
- Addendo srl, Dental Clinic, Catania, Italy
- ECLAT Srl, Spin-off of the University of Catania, Catania, Italy
| | - Salvatore Urso
- ECLAT Srl, Spin-off of the University of Catania, Catania, Italy
- Department of Biological, Geological and Environmental Sciences, University of Catania, Catania, Italy
| | | | - Pasquale Caponnetto
- Center of Excellence for the Acceleration of HArm Reduction, University of Catania, Catania, Italy
- Department of Educational Sciences, Section of Psychology, University of Catania, Catania, Italy
| | - Eugenio Pedullà
- Center of Excellence for the Acceleration of HArm Reduction, University of Catania, Catania, Italy
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Luigi Generali
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | - Ugo Consolo
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | - Vittorio Checchi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Jan Kowalski
- Department of Periodontology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Nowak
- Department of Periodontology, Medical University of Warsaw, Warsaw, Poland
| | - Renata Górska
- Department of Periodontology, Medical University of Warsaw, Warsaw, Poland
| | - Amaliya Amaliya
- Department of Periodontology, Faculty of Dentistry, Universitas Padjadjaran, West Java, Indonesia
| | - Iain Chapple
- Periodontal Research Group, The University of Birmingham & Birmingham Community Healthcare Trust, Birmingham, United Kingdom
| | - Michael Milward
- Periodontal Research Group, The University of Birmingham & Birmingham Community Healthcare Trust, Birmingham, United Kingdom
| | - Robert Maclure
- R Maclure Clinical Research Ltd, Irby, Wirral, United Kingdom
| | - Gianna Maria Nardi
- Department of Dental and Maxillofacial Sciences, Sapienza University, Rome, Italy
| | - Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Nishihara D, Yuki D, Suzuki T, Sakaguchi C, Nagata Y, Kakehi A. A Randomized Control Study in Healthy Adult Smokers to Assess Reduced Exposure to Selected Cigarette Smoke Constituents in Switching to the Novel Heated Tobacco Product DT3.0a. Clin Pharmacol Drug Dev 2024; 13:45-57. [PMID: 37680118 DOI: 10.1002/cpdd.1322] [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: 05/15/2023] [Accepted: 08/06/2023] [Indexed: 09/09/2023]
Abstract
This was a randomized, controlled, open-label, confinement study to assess change in exposure to selected cigarette smoke constituents in healthy adult cigarette smokers who switched to using a novel heated tobacco product (direct heating tobacco system, platform 3, generation 3, version a [DT3.0a]). Sixty nonmenthol cigarette smokers were randomized into 1 of the 4 study groups in which subjects switched to a nonmenthol type of tobacco stick used with DT3.0a, switched to a nonmenthol tobacco stick used with an in-market heated tobacco product device (THS), continued to smoke nonmenthol cigarettes, or stopped smoking. Furthermore, 30 menthol cigarette smokers were randomized into 1 of the 2 study groups in which subjects switched to a menthol tobacco stick used with DT3.0a (mDT3.0a) or continued to smoke menthol cigarettes. Fifteen biomarkers of exposure to selected harmful and potentially harmful constituents (HPHCs) were measured during the 5-day exposure period, followed by assessment of nicotine pharmacokinetics with the assigned product. Results indicated that switching to DT3.0a, THS, and mDT3.0a showed significant exposure reductions in most of the selected HPHCs as compared to continuing smoking cigarettes, with reductions being similar in magnitude to reductions observed with smoking cessation. For DT3.0a and mDT3.0a, nicotine pharmacokinetic parameters were not remarkably different from those obtained for cigarettes and the THS except that a longer time to maximum concentration was obtained following use of the mDT3.0a. In conclusion, switching from smoking cigarettes to DT3.0a or THS use reduced exposure to most of the selected HPHCs, and no remarkable differences were observed for the measurements obtained from different flavors of DT3.0a stick.
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Affiliation(s)
- Daisuke Nishihara
- Scientific and Regulatory Affairs, Japan Tobacco Inc., Minato-Ku, Tokyo, Japan
| | - Dai Yuki
- Scientific and Regulatory Affairs, Japan Tobacco Inc., Minato-Ku, Tokyo, Japan
| | - Takuya Suzuki
- Scientific and Regulatory Affairs, Japan Tobacco Inc., Minato-Ku, Tokyo, Japan
| | - Chikako Sakaguchi
- Scientific and Regulatory Affairs, Japan Tobacco Inc., Minato-Ku, Tokyo, Japan
| | - Yasufumi Nagata
- Scientific and Regulatory Affairs, Japan Tobacco Inc., Minato-Ku, Tokyo, Japan
| | - Aoi Kakehi
- Scientific and Regulatory Affairs, Japan Tobacco Inc., Minato-Ku, Tokyo, Japan
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Kale D, Tattan-Birch H, Brown J, Cox S, Dawkins L, Goniewicz ML, Morris K, Shahab L. Examining acute psychopharmacological effects of nicotine vaping versus heated tobacco products in a randomised crossover study of product naïve adult smokers. Sci Rep 2023; 13:22676. [PMID: 38114686 PMCID: PMC10730620 DOI: 10.1038/s41598-023-49602-3] [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: 04/03/2023] [Accepted: 12/10/2023] [Indexed: 12/21/2023] Open
Abstract
Nicotine vaping products (NVPs) and heated tobacco products (HTPs) are designed to replicate the sensory and behavioural aspects of smoking cigarettes while avoiding combustion. The success of these products as harm reduction tools will partially depend on their ability to satisfy smokers and alleviate nicotine-related withdrawal symptoms. This study aims to compare short-term effects of NVPs (Juul and Aspire PockeX) versus HTPs (IQOS) on smoking-related withdrawal relief, product satisfaction, intention to switch to NVP/HTP, perceptions and attitudes in UK adult cigarette smokers naïve to these products. In a randomized cross-over study, 45 participants visited the lab twice, at each visit trying one of the two products (NVP/HTP) and completing a questionnaire. Responses were normalized on a 0-100% scale and mean differences (MD) between NVP and HTP scores computed, with positive and negative MD values indicating greater endorsement for NVP and HTP, respectively. Cigarette cravings were reduced similarly (~ 20.0%) by both products (MD = 4.5%, 95%Confidence Interval (CI) - 4.8, 13.8). Direct positive effects (MD = - 3.5%, 95%CI - 7.2, 0.2) and adverse side effects (MD = 1.8%, 95%CI - 0.3, 3.8) were comparable after each product use, though marginally favouring HTPs. HTPs were perceived as more satisfying overall (MD = - 13.2%, 95%CI - 20.3 - 6.1) than NVPs but both were perceived as similarly addictive (MD = 3.6%, 95%CI - 4.6, 11.8), relative to cigarettes. Intention to switch to either product was comparable (MD = 4.0%, 95%CI - 5.7, 13.8). Comparison of acute use of NVP versus HTP in a sample of UK smokers naïve to these products suggests that HTPs are perceived as more satisfying than NVPs, though still less satisfying than cigarettes.Registration: The analysis plan was pre-registered, and it is available at https://osf.io/6ymdu.
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Affiliation(s)
- Dimitra Kale
- Department of Behavioural Science and Health, University College London, London, UK.
- SPECTRUM Consortium, London, UK.
| | - Harry Tattan-Birch
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
| | - Sharon Cox
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
| | - Lynne Dawkins
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Kierra Morris
- Department of Behavioural Science and Health, University College London, London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
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Ohara H, Ito S, Takanami Y. Binary classification of users of electronic cigarettes and smokeless tobacco through biomarkers to assess similarity with current and former smokers: machine learning applied to the population assessment of tobacco and health study. BMC Public Health 2023; 23:589. [PMID: 36991369 PMCID: PMC10061900 DOI: 10.1186/s12889-023-15511-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Exposure to harmful and potentially harmful constituents in cigarette smoke is a risk factor for cardiovascular and respiratory diseases. Tobacco products that could reduce exposure to these constituents have been developed. However, the long-term effects of their use on health remain unclear. The Population Assessment of Tobacco and Health (PATH) study is a population-based study examining the health effects of smoking and cigarette smoking habits in the U.S. POPULATION Participants include users of tobacco products, including electronic cigarettes and smokeless tobacco. In this study, we attempted to evaluate the population-wide effects of these products, using machine learning techniques and data from the PATH study. METHODS Biomarkers of exposure (BoE) and potential harm (BoPH) in cigarette smokers and former smokers in wave 1 of PATH were used to create binary classification machine-learning models that classified participants as either current (BoE: N = 102, BoPH: N = 428) or former smokers (BoE: N = 102, BoPH: N = 428). Data on the BoE and BoPH of users of electronic cigarettes (BoE: N = 210, BoPH: N = 258) and smokeless tobacco (BoE: N = 206, BoPH: N = 242) were input into the models to investigate whether these product users were classified as current or former smokers. The disease status of individuals classified as either current or former smokers was investigated. RESULTS The classification models for BoE and BoPH both had high model accuracy. More than 60% of participants who used either one of electronic cigarettes or smokeless tobacco were classified as former smokers in the classification model for BoE. Fewer than 15% of current smokers and dual users were classified as former smokers. A similar trend was found in the classification model for BoPH. Compared with those classified as former smokers, a higher percentage of those classified as current smokers had cardiovascular disease (9.9-10.9% vs. 6.3-6.4%) and respiratory diseases (19.4-22.2% vs. 14.2-16.7%). CONCLUSIONS Users of electronic cigarettes or smokeless tobacco are likely to be similar to former smokers in their biomarkers of exposure and potential harm. This suggests that using these products helps to reduce exposure to the harmful constituents of cigarettes, and they are potentially less harmful than conventional cigarettes.
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Affiliation(s)
- Hiromi Ohara
- Scientific Product Assessment Center, Japan Tobacco Inc, 6-2 Umegaoka, Aoba-ku, Yokohama, 227-8512, Kanagawa, Japan.
| | - Shigeaki Ito
- Scientific Product Assessment Center, Japan Tobacco Inc, 6-2 Umegaoka, Aoba-ku, Yokohama, 227-8512, Kanagawa, Japan
| | - Yuichiro Takanami
- Scientific Product Assessment Center, Japan Tobacco Inc, 6-2 Umegaoka, Aoba-ku, Yokohama, 227-8512, Kanagawa, Japan
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Barrell A. Current Evidence on Tobacco Harm Reduction in Pneumology: Interviews with Two Key Opinion Leaders. EUROPEAN MEDICAL JOURNAL 2022. [DOI: 10.33590/emj/10044289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The negative impact of smoking on the lung is well documented. Cigarette smoke is the cause of 90% of cases of chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. COPD is a progressive and debilitating condition with morbidity and mortality rates similar to myocardial infarction (MI) and stroke. Despite the widely recognised risks, millions of people continue to smoke, in some cases even after receiving a diagnosis of COPD and despite knowing that the habit will accelerate disease progression. While there is no doubt that smoking cessation is the most important health intervention for all cigarette smokers, it can be challenging. Nicotine addiction, social norms and culture, and the length of time it can take smokers to feel the adverse consequences of the habit all contribute to the high cessation failure rate. However, increasing clinical and epidemiological evidence indicates that for those who are unwilling or cannot stop smoking, harm reduction strategies can help reduce exposure to the harmful chemicals and carcinogens released during tobacco combustion. Electronic devices heat processed tobacco without combusting it to deliver an aerosol containing fewer toxic products or harmful and potentially harmful constituents (HPHC) than cigarette smoke. Clinical evidence to support their use is growing. In Japan, for example, a decrease in hospitalisations due to COPD exacerbation after the introduction of such heat-not-burn (HNB), or tobacco heating systems (THS), has been reported.
In this article, Wolfgang Popp, Döbling Doctor’s Center, Privatklinik Döbling, Vienna, Austria, and Klara Szondy, Semmelweis University, Budapest, Hungary, discuss the impact of cigarette smoke on the lung, and how to support smoking cessation in those willing and able to quit smoking. They also explain when strategies that reduce the harmful effects of smoking may be useful, and outline the latest evidence supporting the use of HNB systems.
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Scherer G, Riedel K, Pluym N, Scherer M. Assessment of the Exposure to Aromatic Amines in Users of Various Tobacco/Nicotine Products. ACS OMEGA 2022; 7:41775-41782. [PMID: 36406517 PMCID: PMC9670903 DOI: 10.1021/acsomega.2c06130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Aromatic amines such as ortho-toluidine (o-Tol), 2-aminonaphthalene (2-AN), and 4-aminobiphenyl (4-ABP) are human bladder carcinogens and occur at various workplaces, in ambient air, in food products, as well as in tobacco smoke. In a clinical study comprising a period of 74 h under confinement, we investigated the exposure to these three aromatic amines as well as to 3-aminobiphenyl (3-ABP) by measuring them in urine of habitual users of combustible cigarettes (CCs), electronic cigarettes (ECs), heated tobacco products (HTPs), oral tobacco (OT), and nicotine replacement therapy products (NRTs). Non-users (NU) of any tobacco/nicotine products served as (negative) control group. Smokers (CC) exhibited the highest levels for all four aromatic amines measured, significantly elevated compared to NU and non-CC users. Urinary levels in users of EC, HTP, NRT (mostly nicotine gum), and OT (mostly snus) were not significantly different from those in NU. Users of HTP showed slightly elevated urinary excretion levels of o-Tol, 3-ABP, and 4-ABP compared to some other non-CC groups. Dose markers such as daily consumption, urinary nicotine equivalents (Nequ), and plasma cotinine (CotP) were found to be consistently and significantly correlated with the excretion of aromatic amines for smokers (CC) only. Excretion levels of 3- and 4-ABP in smokers were significantly lower in the urine collected overnight compared to that collected during the day, which is just the opposite of what we observed for other biomarkers in this study. The possible reason for this observation is discussed. In conclusion, in contrast to smoking of CCs, the use of ECs, HTPs, nicotine gum, and oral tobacco was not observed to be associated with significant exposure to the aromatic amines o-Tol, 2-AN, 3-ABP, and 4-ABP. The observed slight increase in o-Tol, 3-ABP, and 4-ABP excretions in HTP users has to be verified in larger studies.
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Morjaria JB, Campagna D, Caci G, O'Leary R, Polosa R. Health impact of e-cigarettes and heated tobacco products in chronic obstructive pulmonary disease: current and emerging evidence. Expert Rev Respir Med 2022; 16:1213-1226. [PMID: 36638185 DOI: 10.1080/17476348.2023.2167716] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Quitting is the only proven method to attenuate the progression of chronic obstructive pulmonary disease (COPD). However, most COPD smokers do not seem to respond to smoking cessation interventions and may benefit by lessening the negative health effects of long-term cigarette smoke exposure by switching to non-combustible nicotine delivery alternatives, such as heated tobacco products (HTPs) and e-cigarettes (ECs). AREAS COVERED Compared with conventional cigarettes, HTPs and ECs offer substantial reduction in exposure to toxic chemicals and have the potential to reduce harm from cigarette smoke when used as tobacco cigarette substitutes. In this review, we examine the available clinical studies and population surveys on the respiratory health effects of ECs and HTPs in COPD patients. EXPERT OPINION The current research on the impact of ECs and HTPs on COPD patients' health is limited, and more high-quality studies are needed to draw definitive conclusions. However, this review provides a comprehensive overview of the available literature for health professionals looking to advise COPD patients on the use of these products. While ECs and HTPs may offer some benefits in reducing harm from cigarette smoke, their long-term effects on COPD patients' health are still unclear.
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Affiliation(s)
- Jaymin B Morjaria
- Department of Respiratory Medicine, Guy's & St Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Davide Campagna
- U.O.C. MCAU, University Teaching Hospital 'Policlinico-Vittorio Emanuele', University of Catania, Catania, Italy
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), Teaching Hospital "Policlinico - V. Emanuele", University of Catania, Catania, Italy
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Grazia Caci
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), Università di Catania, Catania, Italy
| | - Renee O'Leary
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), Teaching Hospital "Policlinico - V. Emanuele", University of Catania, Catania, Italy
- ECLAT Srl, Spin-off of the University of Catania, Catania, Italy
| | - Riccardo Polosa
- U.O.C. MCAU, University Teaching Hospital 'Policlinico-Vittorio Emanuele', University of Catania, Catania, Italy
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), Teaching Hospital "Policlinico - V. Emanuele", University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- ECLAT Srl, Spin-off of the University of Catania, Catania, Italy
- Institute of Internal Medicine, AOU "Policlinico - V. Emanuele - S. Marco", Catania, Italy
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Yuki D, Kikuchi A, Suzuki T, Sakaguchi C, Huangfu D, Nagata Y, Kakehi A. Assessment of the exposure to selected smoke constituents in adult smokers using in-market heated tobacco products: a randomized, controlled study. Sci Rep 2022; 12:18167. [PMID: 36307514 PMCID: PMC9616951 DOI: 10.1038/s41598-022-22997-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/21/2022] [Indexed: 12/31/2022] Open
Abstract
The objectives of this clinical study were to demonstrate a reduction in exposure to selected harmful and potentially harmful constituents (HPHCs) in Japanese healthy adult smokers who switched to four in-market heated tobacco products. Eighty-nine smokers were randomly assigned for five days to one of six study groups: four groups who switched to one of the commercially available heated tobacco products; a group who continued to smoke their own brand of combustible cigarettes (CC); or a group who stopped smoking (SS). Fifteen biomarkers of exposure (BoE) to 14 HPHCs and pyrene were measured at baseline, Day 3 and Day 5 in 24 h urine and breath, under clinical confinement. Product consumption, nicotine uptake and subjective effects were also measured before and after product switching. On Day 5, significant reductions in most BoE relative to the CC group were observed after switching to heated tobacco products. No changes in BoE were observed between baseline and Day 5 in the CC group. Significantly, the magnitude of the reduction in exposure to most of the selected HPHCs observed in the heated tobacco product groups was close to that observed in the SS group.
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Affiliation(s)
- Dai Yuki
- grid.417743.20000 0004 0493 3502Scientific and Regulatory Affairs, Japan Tobacco Inc., 4-1-1 Toranomon Minato-ku, Tokyo, 105-6927 Japan
| | - Akira Kikuchi
- grid.417743.20000 0004 0493 3502Scientific and Regulatory Affairs, Japan Tobacco Inc., 4-1-1 Toranomon Minato-ku, Tokyo, 105-6927 Japan
| | - Takuya Suzuki
- grid.417743.20000 0004 0493 3502Scientific and Regulatory Affairs, Japan Tobacco Inc., 4-1-1 Toranomon Minato-ku, Tokyo, 105-6927 Japan
| | - Chikako Sakaguchi
- grid.417743.20000 0004 0493 3502Scientific and Regulatory Affairs, Japan Tobacco Inc., 4-1-1 Toranomon Minato-ku, Tokyo, 105-6927 Japan
| | - Danting Huangfu
- grid.417743.20000 0004 0493 3502Scientific and Regulatory Affairs, Japan Tobacco Inc., 4-1-1 Toranomon Minato-ku, Tokyo, 105-6927 Japan
| | - Yasufumi Nagata
- grid.417743.20000 0004 0493 3502Scientific and Regulatory Affairs, Japan Tobacco Inc., 4-1-1 Toranomon Minato-ku, Tokyo, 105-6927 Japan
| | - Aoi Kakehi
- grid.417743.20000 0004 0493 3502Scientific and Regulatory Affairs, Japan Tobacco Inc., 4-1-1 Toranomon Minato-ku, Tokyo, 105-6927 Japan
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Caponnetto P, Campagna D, Maglia M, Benfatto F, Emma R, Caruso M, Caci G, Busà B, Pennisi A, Ceracchi M, Migliore M, Signorelli M. Comparing Effectiveness, tolerability, and Acceptability of Heated Tobacco ProductS vs. refillable Electronic cigarettes For cIgaREttes substitution: CEASEFIRE randomized controlled trial (Preprint). JMIR Public Health Surveill 2022; 9:e42628. [PMID: 37014673 PMCID: PMC10131829 DOI: 10.2196/42628] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/07/2022] [Accepted: 02/04/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND People who smoke and who face challenges trying to quit or wish to continue to smoke may benefit by switching from traditional cigarettes to noncombustible nicotine delivery alternatives, such as heated tobacco products (HTPs) and electronic cigarettes (ECs). HTPs and ECs are being increasingly used to quit smoking, but there are limited data about their effectiveness. OBJECTIVE We conducted the first randomized controlled trial comparing quit rates between HTPs and ECs among people who smoke and do not intend to quit. METHODS We conducted a 12-week randomized noninferiority switching trial to compare effectiveness, tolerability, and product satisfaction between HTPs (IQOS 2.4 Plus) and refillable ECs (JustFog Q16) among people who do not intend to quit. The cessation intervention included motivational counseling. The primary endpoint of the study was the carbon monoxide-confirmed continuous abstinence rate from week 4 to week 12 (CAR weeks 4-12). The secondary endpoints included the continuous self-reported ≥50% reduction in cigarette consumption rate (continuous reduction rate) from week 4 to week 12 (CRR weeks 4-12) and 7-day point prevalence of smoking abstinence. RESULTS A total of 211 participants completed the study. High quit rates (CAR weeks 4-12) of 39.1% (43/110) and 30.8% (33/107) were observed for IQOS-HTP and JustFog-EC, respectively. The between-group difference for the CAR weeks 4-12 was not significant (P=.20). The CRR weeks 4-12 values for IQOS-HTP and JustFog-EC were 46.4% (51/110) and 39.3% (42/107), respectively, and the between-group difference was not significant (P=.24). At week 12, the 7-day point prevalence of smoking abstinence values for IQOS-HTP and JustFog-EC were 54.5% (60/110) and 41.1% (44/107), respectively. The most frequent adverse events were cough and reduced physical fitness. Both study products elicited a moderately pleasant user experience, and the between-group difference was not significant. A clinically relevant improvement in exercise tolerance was observed after switching to the combustion-free products under investigation. Risk perception for conventional cigarettes was consistently higher than that for the combustion-free study products under investigation. CONCLUSIONS Switching to HTPs elicited a marked reduction in cigarette consumption among people who smoke and do not intend to quit, which was comparable to refillable ECs. User experience and risk perception were similar between the HTPs and ECs under investigation. HTPs may be a useful addition to the arsenal of reduced-risk alternatives for tobacco cigarettes and may contribute to smoking cessation. However, longer follow-up studies are required to confirm significant and prolonged abstinence from smoking and to determine whether our results can be generalized outside smoking cessation services offering high levels of support. TRIAL REGISTRATION ClinicalTrials.gov NCT03569748; https://clinicaltrials.gov/ct2/show/NCT03569748.
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Affiliation(s)
- Pasquale Caponnetto
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catania, Italy
- Department of Educational Sciences, University of Catania, Catania, Italy
| | - Davide Campagna
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catania, Italy
- Eclat Spin off srl, University of Catania, Catania, Italy
- Department of Clinical & Experimental Medicine, University of Catania, Catania, Italy
- Unità Operativa Complessa Medicina Accettazione Urgenza, University Teaching Hospital, University of Catania, Catania, Italy
| | | | | | - Rosalia Emma
- Department of Clinical & Experimental Medicine, University of Catania, Catania, Italy
| | - Massimo Caruso
- Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Catania, Italy
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Grazia Caci
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Barbara Busà
- Dipartimento Emergenza-Urgenza, Farmacia presidio ospedaliero centro Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, Catania, Italy
| | - Alfio Pennisi
- Department of Respiratory Medicine, Hospital Clinics "Musumeci-Gecas", Catania, Italy
| | | | - Marcello Migliore
- Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
- Minimally Invasive Thoracic Surgery and New Technology, University Hospital of Catania, Catania, Italy
| | - Maria Signorelli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
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Pouly S, Ng WT, Blanc N, Hession P, Zanetti F, Battey JND, de La Bourdonnaye G, Heremans A, Haziza C. Effect of switching from cigarette smoking to the use of the tobacco heating system on periodontitis treatment outcome: Periodontal parameter results from a multicenter Japanese study. FRONTIERS IN DENTAL MEDICINE 2022. [DOI: 10.3389/fdmed.2022.915079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
ObjectivesWe conducted a 6-month randomized clinical study to evaluate the impact of exposure to the aerosol of the Tobacco Heating System (THS), a smoke-free alternative to cigarettes, on changes in periodontal parameters after scaling and root planing (SRP) for periodontitis in subjects who were either continuing to smoke cigarettes or had switched to THS.Material and methodsSmokers with generalized periodontitis were randomized to continue smoking cigarettes or switch to THS use. They underwent SRP for up to 8 weeks, with dental assessments conducted at baseline and at 3 and 6 months after the first treatment.ResultsAfter SRP treatment, all groups showed improvements in the mean full-mouth probing depth (PD), full-mouth clinical attachment level (CAL), gingival inflammation score, plaque control record (PCR), and bleeding on probing (BoP). There were no statistically significant intergroup differences. However, as compared to smokers, THS users showed a trend toward more favorable outcomes in BoP, PCR, and PD improvement at sites with higher initial PD (≥7 mm).ConclusionsOur results indicate that SRP improves the course of periodontitis similarly in cigarette smokers and THS users. The beneficial effects of this treatment might mask the favorable changes that may occur upon modifying one of the several periodontitis risk factors, such as cigarette smoking.Clinical trial registrationClinicalTrials.gov, identifer: NCT03364751.
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Havermans A, van Nierop LE, Pauwels CGGM, Talhout R. “It’s Like Jogging Next to the Highway”: A Qualitative Analysis of the Motivations and Experiences of Single-, Dual-, and Ex-Users of IQOS in The Netherlands. TOXICS 2022; 10:toxics10060283. [PMID: 35736892 PMCID: PMC9229017 DOI: 10.3390/toxics10060283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023]
Abstract
The popularity of heated tobacco products (HTPs) is of concern, as most users are dual users exposed to emissions of both HTPs and conventional cigarettes. Furthermore, HTPs may appeal to young people and non-smokers. This study aims to build intelligence on user experiences in order to inform policy development. We conducted five semi-structured focus group interviews with single-, dual-, and ex-users of the HTP IQOS. The discussions focused on initiation and use, experiences and perception, and knowledge and information needs. We performed a thematic analysis of the transcripts. All users smoked cigarettes and/or roll your own (RYO) tobacco before using HTP. We found that almost all users started using IQOS after being introduced to it by others. Single users successfully quit smoking cigarettes using the IQOS, liked the taste, and experienced physical benefits. Dual users experienced more satisfaction from smoking cigarettes and used the IQOS for specific occasions, such as social situations or in places with smoking bans. All IQOS users described themselves as smokers and considered using the IQOS as an alternative way of smoking. Regulators may consider providing reliable and easily accessible information and regulating points of sale, promotional activities, and product properties such as flavors and devices in order to reduce product attractiveness and discourage use.
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O'Connor R, Schneller LM, Felicione NJ, Talhout R, Goniewicz ML, Ashley DL. Evolution of tobacco products: recent history and future directions. Tob Control 2022; 31:175-182. [PMID: 35241585 DOI: 10.1136/tobaccocontrol-2021-056544] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/04/2021] [Indexed: 12/23/2022]
Abstract
Declines in cigarette smoking prevalence in many countries and the consolidation of the tobacco industry have prompted the introduction of other forms of nicotine delivery. These include electronic nicotine delivery systems (ENDS), heated tobacco products (HTPs) and oral nicotine products (ONPs). Evolving over time, some of these products now deliver nicotine at levels comparable to cigarettes and may serve as effective substitutes for smokers. However, certain products, especially ENDS like JUUL, have also appealed to youth and non-smokers, prompting concerns about expanding nicotine use (and potentially nicotine addiction). The tobacco industry could shift away from primarily promoting cigarettes to promoting ENDS, HTPs and/or ONPs, though at this time it continues to heavily promote cigarettes in low and middle-income countries. Differing regulatory regimes may place upward and downward pressures on both cigarettes and these newer products in terms of population use, and may ultimately drive the extent to which cigarettes are or are not displaced by ENDS, HTPs and/or ONPs in the coming decade.
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Affiliation(s)
- Richard O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA richard.o'
| | - Liane M Schneller
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Nicholas J Felicione
- Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Reinskje Talhout
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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20
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Alarabi AB, Lozano PA, Khasawneh FT, Alshbool FZ. The effect of emerging tobacco related products and their toxic constituents on thrombosis. Life Sci 2022; 290:120255. [PMID: 34953893 PMCID: PMC9118784 DOI: 10.1016/j.lfs.2021.120255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 02/03/2023]
Abstract
Although conventional cigarette smoking is declining, emerging tobacco related products (ETRPs) are currently gaining ground, especially among the youth. These products include electronic cigarettes, waterpipes/hookah, cigars/cigarillo, smokeless tobacco, and heat-not-burn cigarettes. The observed increase in the use of ETRPs is multifactorial and complex but appears to be mainly driven by efforts from the major tobacco companies to reinvent themselves, and present more appealing and allegedly safe(r) tobacco products. However, it is becoming apparent that these products produce substantial amounts of toxic chemicals, many of which have been shown to exert negative health effects, including in the context of the cardiovascular system. Thus, there has been research efforts, albeit limited in general, to characterize the health impact of these products on occlusive/thrombotic cardiovascular diseases (CVD). In this review, we will discuss the potential impact of ETRPs on thrombosis-based CVD. Specifically, we will review how these products and the major chemicals they produce and/or emit can trigger key players in the process of thrombosis, namely inflammation, oxidative stress, platelets, coagulation, and the vascular endothelium, and the relationship between these effects.
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Affiliation(s)
- Ahmed B Alarabi
- Department of Pharmacy Practice, Irma Lerma Rangel College of Pharmacy Texas A&M University, Kingsville, TX, USA
| | - Patricia A Lozano
- Department of Pharmacy Practice, Irma Lerma Rangel College of Pharmacy Texas A&M University, Kingsville, TX, USA
| | - Fadi T Khasawneh
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M University, Kingsville, TX, USA.
| | - Fatima Z Alshbool
- Department of Pharmacy Practice, Irma Lerma Rangel College of Pharmacy Texas A&M University, Kingsville, TX, USA.
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21
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Svendsen C, James A, Matulewicz RS, Moreton E, Sosnowski R, Sherman S, Jaspers I, Gordon T, Bjurlin MA. Carcinogenic biomarkers of exposure in the urine of heated tobacco product users associated with bladder cancer: A systematic review. Urol Oncol 2021; 40:149-160. [PMID: 34920944 DOI: 10.1016/j.urolonc.2021.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/24/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022]
Abstract
To identify biomarkers of exposure present in Heated Tobacco Products (HTPs) users' urine which are associated with bladder cancer and to compare quantitative biomarker levels to those seen in combustible cigarette users. A systematic literature review was conducted in December 2020 with no date limits. Relevant studies that reported quantitative urinary biomarker of exposure in HTP users were included. Biomarkers and their parent compounds were classified by carcinogenicity according to the International Agency for Research on Cancer Monographs and were cross-referenced with the Collaborative on Health and the Environment Toxicant and Disease Database to determine associations with bladder cancer. Our literature search identified 561 articles and 30 clinical trial reports. 11 studies met inclusion criteria. These studies identified 29 biomarkers of exposure present in HTP users' urine, which reflect exposure to 21 unique parent compounds. Of these parent compounds, 14 are carcinogens and 10 have a known link to bladder cancer. HTP users' biomarkers of exposure were present at lower levels than combustible cigarette users but higher than never-smokers. Biomarkers of exposure to bladder carcinogens are present in the urine of HTP users. While levels of these biomarkers appear to be lower than combustible cigarette users, chronic urothelial exposure to bladder carcinogens is concerning and degree of bladder cancer risk remains unknown. Further long-term study is needed to elucidate the bladder cancer risk of HTP use.
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Affiliation(s)
| | | | - Richard S Matulewicz
- Department of Urology, New York University, New York, NY; Department of Population Health, NYU School of Medicine, New York, NY
| | - Elizabeth Moreton
- Health Sciences Library, University of North Carolina, Chapel Hill, NC
| | - Roman Sosnowski
- Department of Urogenital Cancer, Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, Warsaw, Poland
| | - Scott Sherman
- Section on Tobacco, Alcohol and Drug Use, Department of Population Health, NYU School of Medicine, New York, NY
| | - Ilona Jaspers
- Curriculum in Toxicology & Environmental Medicine, University of North Carolina, Chapel Hill, NC; Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC; Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Terry Gordon
- Department of Environmental Medicine, New York University, New York, NY
| | - Marc A Bjurlin
- Department of Urology, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
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22
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Nakama C, Tabuchi T. Use of heated tobacco products by people with chronic diseases: The 2019 JASTIS study. PLoS One 2021; 16:e0260154. [PMID: 34793517 PMCID: PMC8601522 DOI: 10.1371/journal.pone.0260154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
Heated tobacco products (HTPs) have become popular recently. People with chronic disease, such as diabetes, cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD) and cancer, should quit smoking for treatment and recurrence of tobacco-related diseases. However, they have difficulty in quitting smoking, and they may start HTPs use to quit smoking. The purpose of this study is to examine the use of HTPs in people with chronic disease. We used data from an internet study, the Japan Society and New Tobacco Internet Survey (JASTIS). We analyzed 9,008 respondents aged 15-73 years in 2019 using logistic regression. Current use of tobacco products was defined as use within the previous 30 days. Prevalence of current HTP use including dual use and dual use with cigarettes was 9.0% and 6.1% respectively in total. By disease: hypertension 10.2% and 7.4%, diabetes 15.9% and 12.3%, CVD 19.2% and 15.7%, COPD 40.5% and 33.3%, and cancer 17.5% and 11.9%. Diabetes, CVD, COPD, and cancer were positively associated with current use of HTPs (odds ratios (ORs) and 95% confidence intervals (CIs): 1.48 (1.06, 2.07), 2.29 (1.38, 3.80), 3.97(1.73, 9.11), and 3.58(1.99, 6.44), respectively) and dual use of cigarettes and HTPs (ORs and 95% CIs: 2.23 (1.61, 3.09), 3.58 (2.29, 5.60), 7.46 (3.76, 14.80), and 2.57 (1.46, 4.55), respectively) after adjusting for confounders. People with chronic disease were more likely to use HTPs and HTPs together with cigarettes. Further research on the smoking situation of HTPs in patients with chronic diseases is necessary.
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Affiliation(s)
- Chikako Nakama
- Department of Hygiene and Public Health, Kansai Medical University, Hirakata-shi, Osaka, Japan
- Cancer Control Center, Osaka International Cancer Institute, Osaka-shi, Osaka, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka-shi, Osaka, Japan
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23
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Afolalu EF, Langer P, Fischer K, Roulet S, Magnani P. Prevalence and patterns of tobacco and/or nicotine product use in Japan (2017) after the launch of a heated tobacco product ( IQOS®): a cross-sectional study. F1000Res 2021; 10:504. [PMID: 35528952 PMCID: PMC9069173 DOI: 10.12688/f1000research.52407.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 01/10/2023] Open
Abstract
Background: Several smoke-free tobacco and/or nicotine-containing products (TNP) have emerged in recent years to support tobacco harm reduction strategies and reduce individual health risks and population harm relative to continued cigarette smoking. This paper describes the nationwide prevalence and patterns of TNP use in Japan following the commercialization of one such smoke-free TNP, the heated tobacco product IQOS® (Philip Morris International). Methods: We analyzed the first annual data (2016-2017) of two repeated cross-sectional surveys conducted in a representative sample of the Japanese general adult (≥20 years of age) population (N = 4,878) and a sample of adult IQOS users (N = 2,000). We assessed the prevalence of current TNP use according to type of product (cigarettes, IQOS, e-cigarettes, and other TNPs) in the general population and patterns of TNP use in the IQOS user sample. Results: The prevalence of current use across all TNP in the sampled general population was 18.5% (95% confidence interval 17.2-19.5%), with 17.5% (16.4-18.6%) for cigarette smoking and 1.8% (1.4-2.2%) for IQOS use. Regarding the distribution of patterns of use in the IQOS user survey, the majority (63.4% [61.2-65.6%]) were exclusive users of IQOS, followed by 20.6% (18.7-22.5%) of individuals who reported dual use of IQOS and cigarettes. Conclusions: In Japan, cigarette smoking remains the most prevalent way of consuming TNP; however, IQOS is being adopted by a growing number of adult Japanese smokers. These findings serve as baseline data for monitoring trends over time in the use and adoption of potential smoke-free TNP in Japan.
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Affiliation(s)
| | - Peter Langer
- Philip Morris Products S.A., Lausanne, Switzerland
| | | | - Steve Roulet
- Philip Morris Products S.A., Lausanne, Switzerland
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24
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Afolalu EF, Langer P, Fischer K, Roulet S, Magnani P. Prevalence and patterns of tobacco and/or nicotine product use in Japan (2017) after the launch of a heated tobacco product ( IQOS®): a cross-sectional study. F1000Res 2021; 10:504. [PMID: 35528952 PMCID: PMC9069173 DOI: 10.12688/f1000research.52407.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 12/17/2023] Open
Abstract
Background: Several smoke-free tobacco and/or nicotine-containing products (TNP) have emerged in recent years to support tobacco harm reduction strategies and reduce individual health risks and population harm relative to continued cigarette smoking. This paper describes the nationwide prevalence and patterns of TNP use in Japan following the commercialization of one such smoke-free TNP, the heated tobacco product IQOS® (Philip Morris International). Methods: We analyzed the first annual data (2016-2017) of two repeated cross-sectional surveys conducted in a representative sample of the Japanese general adult population (N = 4,878) and a sample of adult IQOS users (N = 2,000). We assessed the prevalence of current TNP use according to type of product (cigarettes, IQOS, e-cigarettes, and other TNPs) in the general population and patterns of TNP use in the IQOS user sample. Results: The prevalence of current use across all TNP in the general adult population was 18.5% (95% confidence interval 17.2-19.5%), with 17.5% (16.4-18.6%) for cigarette smoking and 1.8% (1.4-2.2%) for IQOS use. With regard to the distribution of patterns of use in the IQOS user survey, the majority (63.4% [61.2-65.6%]) were exclusive users of IQOS, followed by 20.6% (18.7-22.5%) of individuals who reported dual use of IQOS and cigarettes. Conclusions: In Japan, cigarette smoking remains the most prevalent way of consuming TNP; however, IQOS is being adopted by a growing number of adult Japanese smokers. These findings serve as baseline data for monitoring trends over time in the use and adoption of potential smoke-free TNP in Japan.
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Affiliation(s)
| | - Peter Langer
- Philip Morris Products S.A., Lausanne, Switzerland
| | | | - Steve Roulet
- Philip Morris Products S.A., Lausanne, Switzerland
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25
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Znyk M, Jurewicz J, Kaleta D. Exposure to Heated Tobacco Products and Adverse Health Effects, a Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6651. [PMID: 34205612 PMCID: PMC8296358 DOI: 10.3390/ijerph18126651] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
Heated tobacco products (HTP) are a form of nicotine delivery intended to be an alternative to traditional cigarettes. HTP tobacco products are sold to consumers as a less harmful alternative to traditional cigarettes, both for users and bystanders. The actual impact of HTP on the health of users and its overall impact on public health is still not fully known. A systematic search of the literature was carried out to identify relevant studies published in English from 2015 to February 2021. The following databases were used: PubMed, Scopus, Elsevier and ClinicalKey. 25 studies (independent and sponsored by the tobacco industry) were considered. The analysis of exposure biomarkers and cardiovascular and respiratory biomarkers showed differences between smokers and people using heated tobacco products. Improvements in clinically relevant risk markers, especially cholesterol, sICAM-1, 8-epi-PGF2α, 11-DTX-B2, HDL and FEV1, were observed compared to persistent cigarette smokers. On the other hand, exposure to IQOS has been reported to alter mitochondrial function, which may further exaggerate airway inflammation, airway remodeling and lung cancer. These products have the potential to increase oxidative stress and increase respiratory tract infections by increasing microbial adherence to the respiratory tract. Our review suggests that HTP products may be products with a reduced risk of chronic diseases, including respiratory and cardiovascular diseases and cancer compared to traditional smoking, although in the case of non-smokers so far, they may pose a risk of their occurrence. Research seems to be necessary to assess the frequency of HTP use and its potential negative health effects.
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Affiliation(s)
- Małgorzata Znyk
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland; (J.J.); (D.K.)
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26
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Polosa R, Morjaria JB, Prosperini U, Busà B, Pennisi A, Gussoni G, Rust S, Maglia M, Caponnetto P. Health outcomes in COPD smokers using heated tobacco products: a 3-year follow-up. Intern Emerg Med 2021; 16:687-696. [PMID: 33754228 PMCID: PMC8049911 DOI: 10.1007/s11739-021-02674-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/13/2021] [Indexed: 12/21/2022]
Abstract
Given that many patients with chronic obstructive pulmonary disease (COPD) smoke despite their symptoms, it is important to understand the long-term health impact of cigarette substitution with heated tobacco products (HTPs). We monitored health parameters for 3 years in COPD patients who substantially attenuated or ceased cigarette consumption after switching to HTPs. Changes in daily cigarette smoking, annualized disease exacerbations, lung function indices, patient-reported outcomes (CAT scores) and 6-minute walk distance (6MWD) from baseline were measured in COPD patients using HTPs at 12, 24 and 36 months. These were compared to a group of age- and sex-matched COPD patients who continued smoking. Complete data sets were available for 38 patients (19 in each group). Subjects using HTPs had a substantial decrease in annualized COPD exacerbations within the group mean (± SD) from 2.1 (± 0.9) at baseline to 1.4 (± 0.8), 1.2 (± 0.8) and 1.3 (± 0.8) at 12-, 24- and 36-month follow-up (p < 0.05 for all visits). In addition, substantial and clinically significant improvements in CAT scores and 6MWD were identified at all three time points in the HTP cohort. No significant changes were observed in COPD patients who continued smoking. This study is the first to describe the long-term health effects of HTP use in COPD patients. Consistent improvements in respiratory symptoms, exercise tolerance, quality of life, and rate of disease exacerbations were observed in patients with COPD who abstained from smoking or substantially reduced their cigarette consumption by switching to HTP use.
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Affiliation(s)
- Riccardo Polosa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), Teaching Hospital "Policlinico-V. Emanuele", University of Catania, Catania, Italy.
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), Università di Catania, Catania, Italy.
- UOC Medicina Interna e Urgenza, AOU "Policlinico-V. Emanuele-San Marco", Via S. Sofia, 78-Ed. 4, p. 2, Stanza 78, 95100, Catania, Italy.
| | - Jaymin B Morjaria
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospital Foundation Trust, Harefield Hospital, Harefield, UK
| | | | - Barbara Busà
- UOC Farmacia Ospedaliera, Hospital ARNAS Garibaldi, Catania, Italy
| | - Alfio Pennisi
- Department of Respiratory Medicine, Hospital Clinics "Musumeci-Gecas", Catania, Italy
| | - Gualberto Gussoni
- Department for Clinical Research "Centro Studi" FADOI (Scientific Society of Internal Medicine), Milan, Italy
| | - Sonja Rust
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), Università di Catania, Catania, Italy
| | - Marilena Maglia
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), Teaching Hospital "Policlinico-V. Emanuele", University of Catania, Catania, Italy
| | - Pasquale Caponnetto
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), Teaching Hospital "Policlinico-V. Emanuele", University of Catania, Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), Università di Catania, Catania, Italy
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27
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Affiliation(s)
- Donald P Tashkin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
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28
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Akiyama Y, Sherwood N. Systematic review of biomarker findings from clinical studies of electronic cigarettes and heated tobacco products. Toxicol Rep 2021; 8:282-294. [PMID: 33552927 PMCID: PMC7850959 DOI: 10.1016/j.toxrep.2021.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Worldwide adoption of electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs) has increased exponentially over the past decade. These products have been proposed as non-combustible alternatives to traditional tobacco products such as cigarettes and may thus reduce the negative health consequences associated with tobacco smoke. However, the overall health impact and safety of using these products remains unclear. This review seeks to provide an updated summary of available evidence on changes to levels of tobacco-related biomarkers to aid the overall assessment of the consequences of using e-cigarettes and HTPs. METHODS A systematic review was conducted through major databases (Medline/PubMed, Scopus, EMBASE) searching for articles directly comparing biomarker levels in humans using e-cigarettes or HTPs and those using combustible cigarettes. We included peer reviewed articles with comparative or longitudinal design and extracted key information for our purpose (type of population, demographics, biomarkers measurements, and health effects). An initial qualitative analysis was performed followed by a summary of findings. RESULTS A total of 44 studies were included from initial citations. The vast majority of the literature reported reductions in levels of biomarkers of tobacco smoke exposure (BOE), especially nicotine, MHBMA, 3-HPMA, S-PMA, 1-OHP and NNAL, when using e-cigarettes and HTPs compared to combustible cigarettes. There was a slight tendency toward a larger reduction in these biomarkers levels with the use of e-cigarettes, although direct comparisons between e-cigarettes and HTPs were lacking. There was also a trend toward positive changes in levels of biomarkers of biological effect (BOBE) with the use of e-cigarettes and HTPs. CONCLUSIONS A comparison of levels of biomarkers of tobacco-related exposure collected in clinical studies revealed that the use of e-cigarettes and HTPs could lead to a significant reduction in exposure to harmful substances compared to combusted cigarettes. In tandem, the health status of e-cigarettes and HTP users, indexed by levels of biomarkers of biological effect showed potential for improvement compared to smoking. However, larger and longer-term population-based studies are needed to further clarify these findings.
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Key Words
- BAT, British American Tobacco
- BOBE, biomarkers of biological effect
- BOE, biomarkers of tobacco smoke exposure
- Biomarkers of biological effect (BOBE)
- Biomarkers of tobacco smoke exposure (BOE)
- CHTP, Carbon-Heated Tobacco Product
- Clinical study
- E-cigarettes, electronic cigarettes
- EHCSS, Electrically Heated Cigarette Smoking System
- EVPs, electronic vapor products
- Electronic cigarette
- FV, Fontem Ventures
- HC, heated cigarette
- HTPs, heated tobacco products
- Heated tobacco products
- JT, Japan Tobacco
- NOS scale, The Newcastle-Ottawa Scale
- NSPS, nicotine-salt pod system
- NTV, Novel Tobacco vapor products
- PMI, Philip Morris International
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- RAI, Reynolds American Inc
- RCT, randomized controlled trial
- RJR, R.J. Reynolds Tobacco Company
- RJRVC, R.J. Reynolds Vapor Company
- RTP, reduced-toxicant-prototype cigarette
- THP, tobacco heating product
- THS, Tobacco Heating System
- UCS, Uncontrolled smoking conditions
- WHO, World Health Organization
- mTHS, Menthol Tobacco Heating System
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Affiliation(s)
- Yukio Akiyama
- Department of Environmental Management, University of Occupational and Environmental Health, Kitakyushu, Japan
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29
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Pouly S, Ng WT, Benzimra M, Soulan A, Blanc N, Zanetti F, Picavet P, Baker G, Haziza C. Effect of Switching to the Tobacco Heating System Versus Continued Cigarette Smoking on Chronic Generalized Periodontitis Treatment Outcome: Protocol for a Randomized Controlled Multicenter Study. JMIR Res Protoc 2021; 10:e15350. [PMID: 33459599 PMCID: PMC7850905 DOI: 10.2196/15350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 04/30/2020] [Accepted: 12/11/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Smoking is a significant risk factor for periodontal disease and tooth loss, as shown in several clinical studies comparing smokers and nonsmokers. Although only a few longitudinal studies have assessed the outcome of periodontal disease after smoking cessation, they indicated that recovery after nonsurgical treatment was more successful in those who had quit smoking. As part of tobacco harm reduction strategies, substituting cigarettes with alternative, less harmful tobacco products is an approach complementary to cessation for smokers who would otherwise continue to smoke. The Tobacco Heating System (THS), developed by Philip Morris International (commercialized as IQOS), is part of the heat-not-burn product category. The IQOS device electrically heats tobacco instead of burning it, at much lower temperatures than cigarettes, thereby producing substantially lower levels of harmful and potentially harmful constituents, while providing the nicotine, taste, ritual, and a sensory experience that closely parallel those of cigarettes. Phillip Morris International has published the results from a broad clinical assessment program, which was established to scientifically substantiate the harm reduction potential of the THS among adult healthy smokers switching to the THS. The program is now progressing toward including adult smokers with smoking-related diseases. OBJECTIVE The goal of this study is to demonstrate favorable changes of periodontal endpoints in response to mechanical periodontal therapy in patients with generalized chronic periodontitis who completely switched to THS use compared with continued cigarette smoking. METHODS This is a randomized controlled two-arm parallel-group multicenter Japanese study conducted in patients with chronic generalized periodontitis who switch from cigarettes to THS compared with smokers continuing to smoke cigarettes for 6 months. The patients were treated with mechanical periodontal therapy as per standard of care in Japan. The primary objective of the study is to demonstrate the beneficial effect of switching to THS use compared with continued cigarette smoking on pocket depth (PD) reduction in all sites with an initial PD≥4 mm. The secondary objectives include evaluation of other periodontal parameters (eg, clinical attachment level or gingival inflammation) and overall oral health status upon switching to THS. Safety was monitored throughout the study. RESULTS In total, 172 subjects were randomized to the cigarette (n=86) or THS (n=86) groups, and all 172 completed the study. The conduct phase of the study is completed, while data cleaning and analyses are ongoing. CONCLUSIONS This study is the first to test a heat-not-burn tobacco product in smokers with an already established disease. The results should further strengthen the evidence that switching to THS can significantly reduce the risk of smoking-related diseases if favorable changes in the evolution of chronic generalized periodontitis after mechanical therapy are found when compared with continued cigarette smoking. TRIAL REGISTRATION ClinicalTrials.gov NCT03364751; https://clinicaltrials.gov/ct2/show/NCT03364751. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15350.
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Affiliation(s)
| | - Wee Teck Ng
- Philip Morris Products SA, Neuchâtel, Switzerland
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30
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van der Plas A, Pouly S, Blanc N, Haziza C, de La Bourdonnaye G, Titz B, Hoeng J, Ivanov NV, Taranu B, Heremans A. Impact of switching to a heat-not-burn tobacco product on CYP1A2 activity. Toxicol Rep 2020; 7:1480-1486. [PMID: 33204648 PMCID: PMC7649435 DOI: 10.1016/j.toxrep.2020.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/18/2020] [Accepted: 10/23/2020] [Indexed: 11/30/2022] Open
Abstract
Background Cigarette smoking induces cytochrome P450 1A2 (CYP1A2) expression and activity, while smoking cessation normalizes the levels of this enzyme. The aim of this publication is to summarize the data on CYP1A2 gene expression and activity in preclinical and clinical studies on the Tobacco Heating System (THS), currently marketed as IQOS® with HEETs®, and to summarize the potential effects on CYP1A2 to be expected upon switching to reduced-risk products (RRPs). Methods We summarized PMI’s preclinical and clinical data on the effects of switching from cigarette smoking to THS. Results Data from four preclinical mouse and rat studies showed that, upon either cessation of cigarette smoke exposure or switching to THS exposure, the upregulation of CYP1A2 observed with exposure to cigarette smoke reverted close to fresh-air levels. Data from four clinical studies yielded similar results on CYP1A2 activity within a time frame of five days. Furthermore, the effects of switching to THS were similar to those seen after smoking cessation. Conclusions Because smoking cessation and switching to either electronic cigarettes or THS seem to have similar effects on CYP1A2 activity, the same measures taken for patients treated with narrow therapeutic index drugs that are metabolized by CYP1A2 and who quit smoking should be recommended for those switching to RRPs.
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Affiliation(s)
- Angela van der Plas
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Sandrine Pouly
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Nicolas Blanc
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Christelle Haziza
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | | | - Bjorn Titz
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Julia Hoeng
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Nikolai V Ivanov
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Brindusa Taranu
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Annie Heremans
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
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Drovandi A, Salem S, Barker D, Booth D, Kairuz T. Human Biomarker Exposure From Cigarettes Versus Novel Heat-Not-Burn Devices: A Systematic Review and Meta-Analysis. Nicotine Tob Res 2020; 22:1077-1085. [PMID: 31641752 DOI: 10.1093/ntr/ntz200] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 10/19/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Novel tobacco products require independent research to assess their safety. This study assessed the current literature for trials comparing levels of biomarkers of exposure (BoE) between conventional cigarettes (CC) and heat-not-burn (HNB) devices. METHODS Ten databases were searched using terms including: "heat not burn," "iqos," "teeps," "mrtp," "tobacco heating," and "glo" between January 1, 2010 and August 13, 2019. Randomized controlled trials (RCTs) assessing comparative BoE levels in humans using either CC or novel HNB devices were eligible. BoE were tabulated, and differences between the intervention and control groups were analyzed and combined using a random-effects meta-analysis. RESULTS Ten nonblinded, RCTs were eligible, involving a total of 1766 participants. Studies regularly reported on 12 BoE (including nicotine). HNB devices assessed included the "IQOS" and "glo" devices and "precursor" (being developed) HNB devices. In comparison to CC, all 12 BoEs assessed were significantly lower for participants assigned to an HNB device. In comparison to smoking abstinence, HNB devices were statistically equivalent for eight BoEs and significantly elevated for four BoEs. CONCLUSIONS This review found that the potential for harm to humans is reduced when using HNB devices compared to CC as indicated by significant reductions in BoE levels. Whilst these results support tobacco manufacturer claims of improved safety, the small number of studies included, limited range of BoE assessed, and involvement of the tobacco industry necessitate further independent research to confirm the HNB devices as being a safer alternative to CC. IMPLICATIONS This study supports claims made by tobacco manufacturers on the improved safety of HNB tobacco devices in comparison to CC. These novel devices lead to reduced exposure to key biomarkers, which are linked to the health consequences attributed to tobacco use. This has strong implications for international public health as well as further research and policy development relating to the safety aspects and legalities of novel tobacco products.
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Affiliation(s)
- Aaron Drovandi
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Saad Salem
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
| | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Debbie Booth
- University Library, University of Newcastle, Newcastle, Australia
| | - Therese Kairuz
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia
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Reduced levels of biomarkers of exposure in smokers switching to the Carbon-Heated Tobacco Product 1.0: a controlled, randomized, open-label 5-day exposure trial. Sci Rep 2020; 10:19227. [PMID: 33154508 PMCID: PMC7644773 DOI: 10.1038/s41598-020-76222-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/09/2020] [Indexed: 12/03/2022] Open
Abstract
In addition to smoking cessation, for those who would otherwise continue to smoke, replacing cigarettes with less harmful alternatives can reduce the harms of smoking. Heating instead of burning tobacco reduces, or eliminates, the formation of harmful and potentially harmful constituents (HPHC) that are found in cigarette smoke. The Carbon-Heated Tobacco Product (CHTP), a heat-not-burn tobacco product, mimics the cigarette smoking ritual. This randomized, open-label, two-arm, parallel-group, short-term confinement study tested the hypothesis that the geometric means of the BoExp levels for subjects switching to CHTP 1.0 for 5 days are lower relative to those continuing to smoke cigarettes. Biomarkers of exposure (BoExp), including nicotine, urinary excretion of mutagenic constituents (Ames test), and cytochrome P450 (CYP) 1A2 activity, were measured in blood and/or 24-h urine samples during ad libitum product use. Nicotine exposure remained at similar levels in individuals using CHTP as in those continuing to smoke cigarettes. Switching to CHTP resulted in marked decreases in all other urinary BoExp (56–97%), carboxyhemoglobin (59%), urinary mutagenic constituents, and CYP1A2 activity compared with continued cigarette smoking. Our results provide evidence of decreased exposure to 15 selected HPHCs in smokers switching from cigarettes to exclusive CHTP use. Trial registration ClinicalTrials.gov: NCT02503254; Date of first registration: 20/07/2015 https://www.clinicaltrials.gov/ct2/show/NCT02503254. Study protocol Study protocol published at: https://www.clinicaltrials.gov/ProvidedDocs/54/NCT02503254/Prot_000.pdf.
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Haziza C, de La Bourdonnaye G, Donelli A, Poux V, Skiada D, Weitkunat R, Baker G, Picavet P, Lüdicke F. Reduction in Exposure to Selected Harmful and Potentially Harmful Constituents Approaching Those Observed Upon Smoking Abstinence in Smokers Switching to the Menthol Tobacco Heating System 2.2 for 3 Months (Part 1). Nicotine Tob Res 2020; 22:539-548. [PMID: 30722062 PMCID: PMC7164581 DOI: 10.1093/ntr/ntz013] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 01/30/2019] [Indexed: 12/11/2022]
Abstract
Introduction The Tobacco Heating System (THS) is a “heat-not-burn” tobacco product designed to generate significantly lower levels of harmful and potentially harmful constituents (HPHCs) and present lower risk of harm than cigarettes. This study assessed the exposure reduction to selected HPHCs in smokers switching to menthol Tobacco Heating System (mTHS) 2.2 compared with smokers continuing smoking menthol cigarettes (mCCs) and smoking abstinence (SA) for 5 days in a confined setting, followed by an 86-day ambulatory period. Methods A total of 160 healthy adult US smokers participated in this randomized, three-arm parallel group, controlled clinical study. Biomarkers of exposure to 16 HPHCs were measured in blood and 24-hour urine. Safety was monitored throughout the study. Information was also gathered on product evaluation, product use, subjective effects, and clinical risk markers (co-publication Part 2). Results Nicotine uptake was comparable in both exposure groups (mTHS:mCC ratio of 96% on day 90). On day 5, biomarker of exposure levels to other HPHCs were reduced by 51%–96% in the mTHS group compared with the mCC group, and these reductions were sustained for most biomarkers of exposure over ambulatory period. After 90 days of use, the level of satisfaction with mTHS and suppression of urge to smoke were comparable to mCC. Conclusion Switching from mCCs to mTHS significantly reduced the exposure to HPHCs to levels approaching those observed in subjects who abstained from smoking for the duration of the study. Implications This study compared the impact of switching to mTHS on biomarkers of exposure, relative to continued smoking or SA. Clinical Significance Trial Registration NCT01989156 (ClinicalTrials.gov).
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Affiliation(s)
| | | | - Andrea Donelli
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Valerie Poux
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Dimitra Skiada
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Rolf Weitkunat
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Gizelle Baker
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Patrick Picavet
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Frank Lüdicke
- PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
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Bosilkovska M, Tran CT, de La Bourdonnaye G, Taranu B, Benzimra M, Haziza C. Exposure to harmful and potentially harmful constituents decreased in smokers switching to Carbon-Heated Tobacco Product. Toxicol Lett 2020; 330:30-40. [PMID: 32380119 DOI: 10.1016/j.toxlet.2020.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/30/2020] [Accepted: 04/16/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND "Heat-not-burn" tobacco products are designed to heat processed tobacco instead of combusting it, thus significantly reducing the formation of harmful and potentially harmful constituents (HPHCs) found in cigarette smoke, and ultimately reducing the risk of smoking-related diseases. The Carbon-Heated Tobacco Product (CHTP), a heat-not-burn tobacco product similar in appearance and use ritual to cigarettes, has been developed for smokers who would otherwise continue smoking as an alternative to cigarettes. To evaluate reduced risk of harm potential of CHTP, it is critical to quantify exposure to HPHCs and consequent biological pathway disturbances involved in disease onset in smokers who switch to CHTP. METHODS In this 2-arm, parallel-group study, adult healthy smokers, not willing to quit, were randomized to switch to CHTP 1.2 (n = 80) or to continue using cigarettes (n = 40) for 5 days in confinement followed by 85 days in an ambulatory setting. Endpoints included biomarkers of exposure (BoExp) to HPHCs, and to nicotine, urinary excretion of mutagenic constituents (Ames assay), CYP1A2 activity, biomarkers of effect, and safety. RESULTS In switchers to CHTP, BoExp were 40%-95% lower compared to smokers after 5 days of product use, with sustained reductions (36%-93%) observed on Day 90. Urine mutagenicity and CYP1A2 activity were also lower in the CHTP group. Exposure to nicotine was higher in the CHTP group at Day 5, but was similar between the two groups at Day 90. Favorable changes in some biomarkers of effect were observed in the CHTP group showing reductions in white blood cell count, soluble intracellular adhesion molecule-1, and 11-dehydro-thromboxane B2, respectively, indicative of reduced inflammation, endothelial dysfunction, and platelet activation. CONCLUSIONS Switching from cigarettes to CHTP resulted in significantly reduced exposure to HPHCs and was associated with observed improvements in some biomarkers of effect representative of pathomechanistic pathways underlying the development of smoking-related diseases.
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Affiliation(s)
- Marija Bosilkovska
- Philip Morris International, Philip Morris Products, S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland.
| | - Cam Tuan Tran
- Philip Morris International, Philip Morris Products, S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Guillaume de La Bourdonnaye
- Philip Morris International, Philip Morris Products, S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Brindusa Taranu
- Philip Morris International, Philip Morris Products, S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Muriel Benzimra
- Philip Morris International, Philip Morris Products, S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Christelle Haziza
- Philip Morris International, Philip Morris Products, S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
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Nga JDL, Hakim SL, Bilal S. Comparison of End Tidal Carbon Monoxide Levels between Conventional Cigarette, Electronic Cigarette and Heated Tobacco Product among Asiatic Smokers. Subst Use Misuse 2020; 55:1943-1948. [PMID: 32552152 DOI: 10.1080/10826084.2020.1781180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Electronic nicotine delivery systems (ENDS) and heated tobacco products (HTPs) are noncombustible tobacco products which have been found to generate aerosols containing lower levels of Harmful and Potentially Harmful Constituents (HPHCs) in comparison to conventional cigarettes. Objective: This quasi experimental study measured and compared the end tidal carbon monoxide (eCO) levels of participants after use of ENDS, HTPs and conventional cigarettes. Methods: In total 45 smokers, each smoking at least 10 conventional cigarettes per day for 5 years participated in the study. Based on their preference, participants used only one of the tobacco products (ENDS, HTPs, or conventional cigarette) and were briefed about the product use based on manufacturer's instructions. The eCO levels were obtained at baseline, followed by 5, 10, 15, 30 and 45 min respectively after the product use. Results: There was significant increase in eCO levels for conventional cigarettes as compared to other modes. Peak eCO levels of 20.2 ± 0.86 ppm, 8.8 ± 1.56 ppm and 6.0 ± 1.36 ppm was achieved at 30 min, 15 min and 10 min for conventional cigarettes, ENDS and HTPs respectively. However, the levels were significantly lower in ENDS and HTPs. Conclusion: Even though ENDS and HTPs may have produced significantly lower eCO than conventional cigarettes, the significantly increasing levels over time from baseline which was not shown before is a cause of concern. As of now, their use as an alternate to cigarettes needs to be considered under regulatory framework.
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Affiliation(s)
- Janice Diong Li Nga
- School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - S Lokman Hakim
- Institute for Research, Development and Innovation and Department of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur
| | - Sobia Bilal
- Department of Children and Community Oral Health, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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Simonavicius E, McNeill A, Shahab L, Brose LS. Heat-not-burn tobacco products: a systematic literature review. Tob Control 2019; 28:582-594. [PMID: 30181382 PMCID: PMC6824610 DOI: 10.1136/tobaccocontrol-2018-054419] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/25/2018] [Accepted: 07/17/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To review peer-reviewed evidence on heat-not-burn tobacco products (HnB), their secondhand emissions and use by humans; to identify differences between independent and industry-funded studies. DATA SOURCES Medline, Embase, PsycINFO, ProQuest, Scopus and Web of Science databases were searched up to 6 November 2017 for studies on HnB published after December 2009; reference lists were screened and other researchers contacted, yielding 637 records. STUDY SELECTION Thirty-one publications on HnB secondhand emissions (n=16) or use by humans (n=15) were selected by two reviewers with excellent agreement (k=0.75). DATA EXTRACTION Data on authors' affiliations, HnB products, secondhand emissions and human exposure were extracted by one reviewer. Two reviewers assessed the quality of experimental HnB studies using the Effective Public Health Practice Project tool. DATA SYNTHESIS Twenty out of 31 studies were affiliated with tobacco industry. Studies on secondhand emissions varied by methodology, products and comparators. Compared with cigarettes, HnB delivered up to 83% of nicotine and reduced levels of harmful and potentially harmful toxicants by at least 62% and particulate matter by at least 75%. Experimental HnB use studies were limited to one product, reductions of human exposure to toxicants varied between 42% and 96%. HnB use suppressed urges to smoke, but participants rated HnB less satisfying than cigarettes. While limited by methodological heterogeneity, findings were largely similar for independent and industry-funded studies. CONCLUSIONS Studies on HnB secondhand emissions and human use were heterogeneous and largely affiliated with the manufacturers. HnB exposed users and bystanders to toxicants, although at substantially lower levels than cigarettes.
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Affiliation(s)
- Erikas Simonavicius
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ann McNeill
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- UK Centre for Tobacco and Alcohol Studies, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
| | - Leonie S Brose
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- UK Centre for Tobacco and Alcohol Studies, UK
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Gale N, McEwan M, Eldridge AC, Fearon IM, Sherwood N, Bowen E, McDermott S, Holmes E, Hedge A, Hossack S, Wakenshaw L, Glew J, Camacho OM, Errington G, McAughey J, Murphy J, Liu C, Proctor CJ. Changes in Biomarkers of Exposure on Switching From a Conventional Cigarette to Tobacco Heating Products: A Randomized, Controlled Study in Healthy Japanese Subjects. Nicotine Tob Res 2019; 21:1220-1227. [PMID: 29912406 PMCID: PMC6698948 DOI: 10.1093/ntr/nty104] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/17/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Smoking is a leading cause of numerous human disorders including pulmonary disease, cardiovascular disease, and cancer. Disease development is primarily caused by exposure to cigarette smoke constituents, many of which are known toxicants. Switching smokers to modified risk tobacco products (MRTPs) has been suggested as a potential means to reduce the risks of tobacco use, by reducing such exposure. METHODS This randomized, controlled study investigated whether biomarkers of toxicant exposure (BoE) were reduced when smokers switched from smoking combustible cigarettes to using a novel (glo™/THP1.0) or in-market comparator (iQOS/THS) tobacco heating product (THP). One hundred eighty Japanese smokers smoked combustible cigarettes during a 2-day baseline period, followed by randomization to either continue smoking cigarettes, switch to using mentholated or non-mentholated variants of glo™, switch to using a non-mentholated variant of iQOS, or quit nicotine and tobacco product use completely for 5 days. Baseline and post-randomization 24-h urine samples were collected for BoE analysis. Carbon monoxide was measured daily in exhaled breath (eCO). RESULTS On day 5 after switching, urinary BoE (excluding for nicotine) and eCO levels were significantly (p < .05) reduced by medians between 20.9% and 92.1% compared with baseline in all groups either using glo™ or iQOS or quitting tobacco use. Between-group comparisons revealed that the reductions in the glo™ groups were similar (p > .05) to quitting in many cases. CONCLUSIONS glo™ or iQOS use for 5 days reduced exposure to smoke toxicants in a manner comparable to quitting tobacco use. THPs are reduced exposure tobacco products with the potential to be MRTPs. IMPLICATIONS This clinical study demonstrates that when smokers switched from smoking combustible cigarettes to using tobacco heating products their exposure to smoke toxicants was significantly decreased. In many cases, this was to the same extent as that seen when they quit smoking completely. This may indicate that these products have the potential to be reduced exposure and/or reduced risk tobacco products when used by smokers whose cigarette consumption is displaced completely. CLINICAL TRIAL REGISTRATIONS ISRCTN14301360 and UMIN000024988.
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Affiliation(s)
- Nathan Gale
- British American Tobacco (Investments) Limited, Research and Development, Southampton, UK
| | - Mike McEwan
- British American Tobacco (Investments) Limited, Research and Development, Southampton, UK
| | - Alison C Eldridge
- British American Tobacco (Investments) Limited, Research and Development, Southampton, UK
| | | | | | - Edward Bowen
- Early Clinical Services Medical Writing, Global Medical and Regulatory Writing, Covance Clinical Research Unit Limited, Leeds, UK
| | - Simon McDermott
- Early Clinical Development, Covance Clinical and Periapproval Services Limited, Leeds, UK
| | - Emma Holmes
- Early Clinical Development, Covance Clinical and Periapproval Services Limited, Leeds, UK
| | - Andrew Hedge
- Early Clinical Development, Covance Clinical and Periapproval Services Limited, Leeds, UK
| | - Stuart Hossack
- Early Clinical Development, Covance Clinical and Periapproval Services Limited, Leeds, UK
| | - Louise Wakenshaw
- Early Clinical Services Medical Writing, Global Medical and Regulatory Writing, Covance Clinical Research Unit Limited, Leeds, UK
| | - James Glew
- Early Clinical Development, Covance Clinical and Periapproval Services Limited, Leeds, UK
| | - Oscar M Camacho
- British American Tobacco (Investments) Limited, Research and Development, Southampton, UK
| | - Graham Errington
- British American Tobacco (Investments) Limited, Research and Development, Southampton, UK
| | - John McAughey
- British American Tobacco (Investments) Limited, Research and Development, Southampton, UK
| | - James Murphy
- British American Tobacco (Investments) Limited, Research and Development, Southampton, UK
| | - Chuan Liu
- British American Tobacco (Investments) Limited, Research and Development, Southampton, UK
| | - Christopher J Proctor
- British American Tobacco (Investments) Limited, Research and Development, Southampton, UK
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Sponsiello-Wang Z, Langer P, Prieto L, Dobrynina M, Skiada D, Camille N, Weitkunat R, Lüdicke F. Household Surveys in the General Population and Web-Based Surveys in IQOS Users Registered at the Philip Morris International IQOS User Database: Protocols on the Use of Tobacco- and Nicotine-Containing Products in Germany, Italy, and the United Kingdom (Greater London), 2018-2020. JMIR Res Protoc 2019; 8:e12061. [PMID: 31094340 PMCID: PMC6532333 DOI: 10.2196/12061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 12/26/2022] Open
Abstract
Background Philip Morris International (PMI) has developed a novel heat-not-burn tobacco product, Tobacco Heating System (THS), which is marketed under the brand name of IQOS with HEETS (IQOS). The aerosol generated by THS has substantially fewer toxicants than combustible cigarette smoke, although the extent of the reduction of harmful and potentially harmful constituents reported varies between studies. To evaluate the potential harm reduction associated with IQOS use, the assessment of the uptake and continued use of IQOS in the context of all other tobacco- and nicotine-containing products is crucial. In March 2018, PMI launched cross-sectional surveys in Germany, Italy, and the United Kingdom (Greater London) to estimate the prevalence and use patterns of IQOS and other tobacco- and nicotine-containing products use in these 3 markets following the commercialization of IQOS. This study describes the protocol of the surveys. Objective The objectives of these surveys are to estimate the prevalence of tobacco- and nicotine-containing products use; describe past and current patterns of use; and explore their associations with self-reported health, motivation to use, risk perceptions, and perceived aesthetic changes. Methods The overall design of the surveys is similar in all 3 countries. Repeated cross-sectional surveys are being conducted annually over 3 consecutive years (2018 to 2020) and in 2 samples: a representative sample of the general population and a sample of IQOS users. A total of 6085 adults per year will be selected from the general population for each survey through multistage stratified sampling, and participants will respond to face-to-face computer-assisted personal interviews. In addition, 1404, 1384, and 1246 IQOS users per year in Germany, Italy, and Greater London, respectively, will be randomly selected from the PMI IQOS user database and will be invited to complete the Web-based survey using computer-assisted self-interviews. The Smoking Questionnaire is used to assess the tobacco use patterns of the participants. Results The recruitment of the general population sample began in March 2018 and that of the IQOS user sample began in April 2018. The data collection is ongoing, and the results of the first year data analysis are expected to be available by June 2019. Conclusions As the design of the 3 surveys is similar, the results will allow for cross-countries comparison of the prevalence of IQOS and other tobacco- and nicotine-containing products use as well as patterns of use and associated factors. International Registered Report Identifier (IRRID) DERR1-10.2196/12061
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Affiliation(s)
| | - Peter Langer
- Philip Morris Products SA, Neuchatel, Switzerland
| | - Luis Prieto
- Philip Morris Products SA, Neuchatel, Switzerland
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Martin F, Talikka M, Ivanov NV, Haziza C, Hoeng J, Peitsch MC. A Meta-Analysis of the Performance of a Blood-Based Exposure Response Gene Signature Across Clinical Studies on the Tobacco Heating System 2.2 (THS 2.2). Front Pharmacol 2019; 10:198. [PMID: 30971916 PMCID: PMC6444181 DOI: 10.3389/fphar.2019.00198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/18/2019] [Indexed: 11/28/2022] Open
Abstract
As part of emerging tobacco harm reduction strategies, modified risk tobacco products (MRTP) are being developed to offer alternatives that have the potential to reduce the individual risk and population harm compared with smoking cigarettes for adult smokers who want to continue using tobacco and nicotine products. MRTPs are defined as any tobacco products that are distributed for use to reduce harm or the risk of tobacco-related disease associated with commercially marketed tobacco products. One such candidate MRTP is the Tobacco Heating System (THS) 2.2, which does not burn tobacco but instead heats it, thus producing significantly reduced levels of harmful and potentially harmful constituents compared with cigarettes. The clinical assessment of candidate MRTPs requires the development of exposure-response markers to distinguish current smokers from either nonsmokers or former smokers with high specificity and sensitivity. Toward this end, a whole blood-derived gene signature was previously developed and reported. Four randomized, controlled, open-label, three-arm parallel group reduced exposure clinical studies have been conducted with subjects randomized to three arms: switching from cigarettes to THS 2.2, continuous use of cigarettes, or smoking abstinence. These clinical studies had an investigational period of 5 days in confinement, which was followed by an 85-day ambulatory period in two studies. Here we tested the previously developed blood-derived signature on the samples derived from those clinical studies. We showed that in all four studies, the signature scores were reduced consistently in subjects who either stopped smoking or switched to THS 2.2 compared with subjects who continued smoking cigarettes.
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Affiliation(s)
- Florian Martin
- Philip Morris International Research and Development, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Marja Talikka
- Philip Morris International Research and Development, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Nikolai V Ivanov
- Philip Morris International Research and Development, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Christelle Haziza
- Philip Morris International Research and Development, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Julia Hoeng
- Philip Morris International Research and Development, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Manuel C Peitsch
- Philip Morris International Research and Development, Philip Morris Products S.A., Neuchâtel, Switzerland
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Dautzenberg B, Dautzenberg MD. [Systematic analysis of the scientific literature on heated tobacco]. Rev Mal Respir 2019; 36:82-103. [PMID: 30429092 DOI: 10.1016/j.rmr.2018.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The tobacco industry (TI) reports that heated tobacco reduces risk of tobacco use and will replace cigarettes. An analysis of the scientific literature was conducted in order to enlighten professionals and decision-makers. METHOD After a Medline query in February 2018, a systematic analysis was conducted. RESULTS Of the 100 papers published in 2008-2018, 75 have authors affiliated or linked to TI. Emissions contain gases, droplets and solid particles, so are smokes. The main products are: THS2.2 (Iqos®) which heats mini-cigarettes at 340°C, the THP1.0 (Glo®) which heats at 240°C sticks delivering about half as much nicotine, Ploom® which uses reconstituted tobacco microcapsules heated at 180°C. Under the experimental conditions, there is a reduction of toxic emissions and biological effects, but the expected risk reduction is not demonstrated. Symptoms related to passive smoking are described. The 4 epidemiological articles report that heated tobacco is used in 10 to 45% of cases by non-smokers and demonstrate the effectiveness of TI promotion campaigns. Thus, the THS2.2 is more a gateway to smoking (20%) than an exit door (11%); moreover, it is not expected risk reduction among the 69% who are mixed users. CONCLUSIONS While reducing emissions is documented, reducing the risk to the smoker who switches to heated-tobacco remains to be demonstrated. On the other hand, the worsening of the global tobacco risk related to the promotion of the products by the TI is anticipated, justifying that the authorities take the appropriate measures to control the promotion of heated tobacco.
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Affiliation(s)
- B Dautzenberg
- Service de pharmacologie, Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Consultation de médecine, hôpital Marmottan, 75017 Paris, France; Consultation de tabacologie, institut Arthur-Vernes, 75006 Paris, France; Paris sans tabac, 14, avenue Bosquet, 75007 Paris, France.
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Adriaens K, Gucht DV, Baeyens F. IQOS TM vs. e-Cigarette vs. Tobacco Cigarette: A Direct Comparison of Short-Term Effects after Overnight-Abstinence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2902. [PMID: 30567400 PMCID: PMC6313326 DOI: 10.3390/ijerph15122902] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022]
Abstract
Introduction: Research from Philip Morris International's science division on its Heat-not-Burn product IQOSTM focused on its chemical, toxicological, clinical, and behavioral aspects. Independent research on the experiences and behavioral aspects of using IQOSTM, and how it compares to e-cigarettes, is largely lacking. The current randomized, cross-over behavioral trial tried to bridge the latter gaps. Methods: Participants (n = 30) came to the lab on three consecutive days after being overnight smoking abstinent. During each session, participants used one of three products (cigarette, e-cigarette, or IQOSTM) for five minutes. Exhaled CO (eCO) measurements and questionnaires were repeatedly administered throughout the session. Results: Smoking a cigarette for five minutes resulted in a significant increase of eCO, whereas using an IQOSTM resulted in a small but reliable increase (0.3 ppm). Vaping did not affect eCO. Cigarette craving reduced significantly after product use, with the decline being stronger for smoking than for e-cigarettes or IQOSTM. Withdrawal symptoms declined immediately after smoking or using IQOSTM, and with some delay after vaping. IQOSTM scored higher in terms of subjective reward/satisfaction and was slightly preferred to the e-cigarette. Discussion: Short-term use of IQOSTM has a minimal impact on eCO, is equally effective in reducing cigarette craving and withdrawal symptoms as an e-cigarette, and is slightly preferred.
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Affiliation(s)
- Karolien Adriaens
- Faculty of Psychology and Educational Sciences, KU Leuven-University Leuven, Tiensestraat 102, 3000 Leuven, Belgium.
| | - Dinska Van Gucht
- Faculty of Psychology and Educational Sciences, KU Leuven-University Leuven, Tiensestraat 102, 3000 Leuven, Belgium.
- Applied Psychology Unit, Thomas More University of Applied Sciences, Molenstraat 8, 2018 Antwerp, Belgium.
| | - Frank Baeyens
- Faculty of Psychology and Educational Sciences, KU Leuven-University Leuven, Tiensestraat 102, 3000 Leuven, Belgium.
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Sharman A, Zhussupov B, Sharman D, Kim I, Yerenchina E. Lung Function in Users of a Smoke-Free Electronic Device With HeatSticks (iQOS) Versus Smokers of Conventional Cigarettes: Protocol for a Longitudinal Cohort Observational Study. JMIR Res Protoc 2018; 7:e10006. [PMID: 30401669 PMCID: PMC6246972 DOI: 10.2196/10006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/16/2018] [Accepted: 08/13/2018] [Indexed: 12/13/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a global public health problem. It is the third-leading cause of death in the world, the fourth leading cause of death in Kazakhstan, and is strongly associated with smoking. Smoking cessation reduces the severity of respiratory symptoms and COPD exacerbations. Heated tobacco products, such as HeatSticks heated by the iQOS device, a smoke-free electronic device, may serve as less risky alternatives to conventional combustible cigarettes. Objective The purpose of this study is to evaluate frequency of exacerbations, respiratory symptoms, physical exercise intolerance, and abnormal lung functions, as well as other parameters and comorbidities among men and women aged 40-59 residing in Almaty, Kazakhstan, who use iQOS with HeatSticks compared to smokers of conventional cigarettes. Methods This is a 5-year single-center cohort observational study. It includes two cohorts of participants consisting of men and women aged 40-59 residing in the city of Almaty, Kazakhstan: (1) smokers of combustible cigarettes (control group) and (2) users of iQOS with HeatSticks (exposure group). The study has baseline and periodic (ie, annual) comprehensive clinical assessments, as well as continuous COPD case-finding activities and registration of acute respiratory exacerbations over the course of the 5-year observation period. Study measures include spirometry, chest computed tomography, electrocardiography, physical exams, laboratory testing of serum for biomarkers of inflammation and metabolic syndrome, anthropometry, and the 6-minute walk test. Information about COPD symptoms will be collected using the COPD Assessment Test. Results Participant recruitment began December 2017, and enrollment is expected to last until late summer 2018. Conclusions This is the first cohort observational study in Kazakhstan to assess differences in lung function between users of the heated tobacco product, iQOS with HeatSticks, and smokers of conventional combustible cigarettes. The study results will add to knowledge on whether switching from combustible cigarettes to iQOS with HeatSticks affects respiratory symptoms and diseases, including the development and progression of COPD. Trial Registration ClinicalTrials.gov NCT03383601; https://clinicaltrials.gov/ct2/show/NCT03383601 (Archived by WebCite at http://www.webcitation.org/72BYoAKxa) International Registered Report Identifier (IRRID) PRR1-10.2196/10006
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Affiliation(s)
- Almaz Sharman
- Academy of Preventive Medicine of Kazakhstan, Clinical Research Unit, Almaty, Kazakhstan
| | - Baurzhan Zhussupov
- Academy of Preventive Medicine of Kazakhstan, Clinical Research Unit, Almaty, Kazakhstan
| | - Dana Sharman
- Academy of Preventive Medicine of Kazakhstan, Clinical Research Unit, Almaty, Kazakhstan
| | - Irina Kim
- Synergy Research Group Kazakhstan, Almaty, Kazakhstan
| | - Elmira Yerenchina
- Academy of Preventive Medicine of Kazakhstan, Clinical Research Unit, Almaty, Kazakhstan
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43
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Caponnetto P, Maglia M, Prosperini G, Busà B, Polosa R. Carbon monoxide levels after inhalation from new generation heated tobacco products. Respir Res 2018; 19:164. [PMID: 30170593 PMCID: PMC6119326 DOI: 10.1186/s12931-018-0867-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/20/2018] [Indexed: 01/20/2023] Open
Abstract
Heated tobacco products (HTPs) are new tech devices that release nicotine and other volatile compounds into an inhalable aerosol by heating the tobacco. At their operating temperatures, tobacco combustion is unlikely. The aim of this randomized cross-over study was to measure the exposure levels of the combustion marker, carbon monoxide in the exhaled breath (eCO) of subjects after use of two HTPs and to compare these levels with participants’ own brand of cigarettes. A total of 12 healthy smokers who reported smoking ≥10 conventional cigarettes per day for at least 5 years took part in the study. Product administration consisted of a first round of 10 puffs, which was followed by an identical second round after a 5 min pause in between rounds. After obtaining a baseline eCO value, this measure was recorded at 5, 10, 15, 30, and 45 min after the first puff of the first round. In contrast to combustible cigarettes, no eCO elevations were observed in the exhaled breath after use of the HTPs under investigation in any of the study participants.
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Affiliation(s)
- Pasquale Caponnetto
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria "Policlinico-V. Emanuele", Università di Catania, Catania, Italy.,Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Catania, Italy
| | - Marilena Maglia
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria "Policlinico-V. Emanuele", Università di Catania, Catania, Italy.,Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Catania, Italy
| | | | - Barbara Busà
- UOC Farmacia Ospedaliera, ARNAS Garibaldi, Catania, Italy
| | - Riccardo Polosa
- Centro per la Prevenzione e Cura del Tabagismo (CPCT), Azienda Ospedaliero-Universitaria "Policlinico-V. Emanuele", Università di Catania, Catania, Italy. .,Dipartimento di Medicina Clinica e Sperimentale, Università di Catania, Catania, Italy. .,Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), Università di Catania, Catania, Italy. .,UOC di Medicina Interna e d'Urgenza, Edificio 4, Piano 3, AOU "Policlinico-V. Emanuele", Via S. Sofia 78, 95123, Catania, Italy.
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44
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Yuki D, Takeshige Y, Nakaya K, Futamura Y. Assessment of the exposure to harmful and potentially harmful constituents in healthy Japanese smokers using a novel tobacco vapor product compared with conventional cigarettes and smoking abstinence. Regul Toxicol Pharmacol 2018; 96:127-134. [PMID: 29738810 DOI: 10.1016/j.yrtph.2018.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 01/20/2023]
Abstract
The objectives of this clinical study were to demonstrate a reduction in exposure to selected harmful and potentially harmful constituents (HPHCs), and to assess product use behavior, in Japanese healthy adult smokers who switched to a novel tobacco vapor product (NTV). 60 smokers were randomly assigned for 5 days to either (a) a group who switched to an NTV (n = 20), (b) a group who continued to smoke their own brand of conventional cigarettes (CC, n = 20) or (c) a smoking abstinence group (SA, n = 20). Fifteen biomarkers of exposure (BoEs) to 14 HPHCs and pyrene were measured at baseline, day 3 and 5. Product use behavior was assessed by measuring product consumption, nicotine uptake and puffing topography. During investigations, increases were observed in product consumption and total puff volume in NTV group subjects as compared to baseline. Additionally, nicotine uptake in the NTV group was approximately half that observed in the CC group. BoE values were significantly reduced in the NTV group as compared to those in the CC group. Significantly, the magnitude of the reduction in exposure to HPHCs observed in the NTV group (49-94%) was close to that observed for the SA group (39-95%).
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Affiliation(s)
- Dai Yuki
- Scientific Product Assessment Center, R&D Group, Japan Tobacco Inc., Japan.
| | - Yuki Takeshige
- Scientific Product Assessment Center, R&D Group, Japan Tobacco Inc., Japan
| | - Kyoko Nakaya
- Scientific Product Assessment Center, R&D Group, Japan Tobacco Inc., Japan
| | - Yasuyuki Futamura
- Scientific Product Assessment Center, R&D Group, Japan Tobacco Inc., Japan
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45
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Motooka Y, Matsui T, Slaton RM, Umetsu R, Fukuda A, Naganuma M, Hasegawa S, Sasaoka S, Hatahira H, Iguchi K, Nakamura M. Adverse events of smoking cessation treatments (nicotine replacement therapy and non-nicotine prescription medication) and electronic cigarettes in the Food and Drug Administration Adverse Event Reporting System, 2004-2016. SAGE Open Med 2018; 6:2050312118777953. [PMID: 29844912 PMCID: PMC5966839 DOI: 10.1177/2050312118777953] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 04/26/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives: Several smoking cessation treatments (nicotine replacement therapy and non-nicotine prescription medication) and electronic cigarettes are widely used. We evaluated the adverse events related to smoking cessation treatments and electronic cigarettes in the US Food and Drug Administration Adverse Event Reporting System database. Methods: We analyzed reports of adverse events associated with smoking cessation treatment and electronic cigarettes terms dated between January 2004 and December 2016. We used the reporting odds ratio with 95% confidence intervals to detect a signal for each adverse event. Results: In total, 8,867,135 reports in the Food and Drug Administration Adverse Event Reporting System database were analyzed. The numbers of adverse events for nicotine replacement therapy (transdermal, buccal, oral, and respiratory administration) were 1673, 1016, 425, and 56, respectively. Nicotine replacement therapy (transdermal, buccal, and oral) demonstrated adverse events of nausea, nicotine dependence, and dizziness. For nicotine (transdermal) exposure, the top 5 adverse events reported were nausea (149 cases, reporting odds ratio: 2.28 (95% confidence interval: 1.92–2.69)), dizziness (132 cases, reporting odds ratio: 3.04 (95% confidence interval: 2.54–3.63)), application site erythema (108 cases, reporting odds ratio: 32.52 (95% confidence interval: 26.74–39.55)), headache (98 cases, reporting odds ratio: 1.84 (95% confidence interval: 1.50–2.25)), and dyspnea (94 cases, reporting odds ratio: 1.93 (95% confidence interval: 1.57–2.38)). Many cases of improper use of nicotine replacement therapies were reported. Nausea, depression, abnormal dreams, insomnia, and other adverse events were reported for varenicline. Insomnia, rash, anxiety, and dizziness were reported for bupropion. We observed electronic cigarettes–related adverse events such as dizziness, dyspnea, nausea, heart rate increased, and tremor. Conclusion: Our findings suggest that an association exists between nicotine-related adverse events and nicotine replacement therapy. Healthcare professionals should closely monitor smokers trying to quit nicotine use for the misuse of nicotine replacement therapy. These findings may be informative to healthcare professionals in order to improve the management of smoking cessation treatment.
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Affiliation(s)
- Yumi Motooka
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, Gifu, Japan
| | - Toshinobu Matsui
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, Gifu, Japan
| | - Rachel M Slaton
- Department of Pharmacy Practice, McWhorter School of Pharmacy, Samford University, Birmingham, AL, United States
| | | | - Akiho Fukuda
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, Gifu, Japan
| | - Misa Naganuma
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, Gifu, Japan
| | - Shiori Hasegawa
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, Gifu, Japan
| | - Sayaka Sasaoka
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, Gifu, Japan
| | - Haruna Hatahira
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, Gifu, Japan
| | - Kazuhiro Iguchi
- Laboratory of Community Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Mitsuhiro Nakamura
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, Gifu, Japan
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Martin F, Vuillaume G, Baker G, Sponsiello-Wang Z, Ricci PF, Lüdicke F, Weitkunat R. Quantifying the risk-reduction potential of new Modified Risk Tobacco Products. Regul Toxicol Pharmacol 2018; 92:358-369. [PMID: 29258927 DOI: 10.1016/j.yrtph.2017.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/04/2017] [Accepted: 12/15/2017] [Indexed: 12/31/2022]
Abstract
Quantitative risk assessment of novel Modified Risk Tobacco Products (MRTP) must rest on indirect measurements that are indicative of disease development prior to epidemiological data becoming available. For this purpose, a Population Health Impact Model (PHIM) has been developed to estimate the reduction in the number of deaths from smoking-related diseases following the introduction of an MRTP. One key parameter of the model, the F-factor, describes the effective dose upon switching from cigarette smoking to using an MRTP. Biomarker data, collected in clinical studies, can be analyzed to estimate the effects of switching to an MRTP as compared to quitting smoking. Based on transparent assumptions, a link function is formulated that translates these effects into the F-factor. The concepts of 'lack of sufficiency' and 'necessity' are introduced, allowing for a parametrization of a family of link functions. These can be uniformly sampled, thus providing different 'scenarios' on how biomarker-based evidence can be translated into the F-factor to inform the PHIM.
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Affiliation(s)
- Florian Martin
- Philip Morris International Research & Development, Neuchâtel, Switzerland
| | - Gregory Vuillaume
- Philip Morris International Research & Development, Neuchâtel, Switzerland
| | - Gizelle Baker
- Philip Morris International Research & Development, Neuchâtel, Switzerland
| | | | | | - Frank Lüdicke
- Philip Morris International Research & Development, Neuchâtel, Switzerland
| | - Rolf Weitkunat
- Philip Morris International Research & Development, Neuchâtel, Switzerland.
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47
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Ichitsubo H, Kotaki M. Indoor air quality (IAQ) evaluation of a Novel Tobacco Vapor (NTV) product. Regul Toxicol Pharmacol 2018; 92:278-294. [PMID: 29277437 DOI: 10.1016/j.yrtph.2017.12.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/03/2017] [Accepted: 12/21/2017] [Indexed: 11/27/2022]
Abstract
The impact of using a Novel Tobacco Vapor (NTV) product on indoor air quality (IAQ) was simulated using an environmentally-controlled chamber. Three environmental simulations were examined; two non-smoking areas (conference room and dining room) and one ventilated smoking area (smoking lounge). IAQ was evaluated by (i) measuring constituents in the mainstream NTV product emissions, (ii) and by determining classical environmental tobacco smoke (ETS) and representative air quality markers. Analysis of the mainstream emissions revealed that vapor from the NTV product is chemically simpler than cigarette smoke. ETS markers (RSP, UVPM, FPM, solanesol, nicotine, 3-ethenylpyridine), volatile organic compound (toluene), carbon monoxide, propylene glycol, glycerol, and triacetin were below the limit of detection or the limit of quantification in both the non-smoking and smoking environments after using the NTV product. The concentrations of ammonia, carbonyls (formaldehyde, acetaldehyde, and acetone), and total volatile organic compounds were the same levels found in the chamber without NTV use. There was no significant increase in the levels of formaldehyde, acetone or ammonia in exhaled breath following NTV use. In summary, under the simulations tested, the NTV product had no measurable effect on the IAQ, in either non-smoking or smoking areas.
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Affiliation(s)
- Hirokazu Ichitsubo
- Tobacco Science Research Center, Japan Tobacco Inc., 6-2 Umegaoka, Aoba-ku, Yokohama, Kanagawa 227-8512, Japan.
| | - Misato Kotaki
- Corporate, Scientific and Regulatory Affairs Div., Tobacco Business Headquarters, Japan Tobacco Inc., JT Bldg. 2-2-1 Toranomon, Minato-ku, Tokyo, 105-8422, Japan
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48
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Peitsch MC, Polosa R, Proctor C, Hassler T, Gaca M, Hill E, Hoeng J, Hayes AW. Next-generation tobacco and nicotine products. TOXICOLOGY RESEARCH AND APPLICATION 2018. [DOI: 10.1177/2397847318773701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A framework for the assessment of novel next-generation tobacco and nicotine products with the potential to reduce health risks compared with cigarettes should integrate scientific studies incorporating nonclinical, clinical, and population studies approaches. These products should have lower emissions and exhibit reduced biological effects compared with those of cigarettes, ideally approaching those of smoking cessation. The products should also be acceptable cigarette alternatives for current smokers, while not appealing to nonsmokers or former smokers. Validating harm reduction and promoting regulatory acceptance of the assessment methods require a collaborative approach by industry, independent reviewers, the public health community, and regulatory agencies. This article summarizes the science and approaches applied and considered to substantiate tobacco harm reduction in the light of regulatory requirements, presented at the 53rd Congress of the European Societies of Toxicology, 2017.
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Affiliation(s)
- Manuel C Peitsch
- Philip Morris International R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - Riccardo Polosa
- Dipartimento di Medicina Clinica e Sperimentale, University of Catania, Catania, Italy
| | - Christopher Proctor
- British American Tobacco (Investments) Ltd., Group Research and Development, Southampton, UK
| | - Thord Hassler
- Swedish Match, European Division, Gothenburg, Sweden
| | - Marianna Gaca
- British American Tobacco (Investments) Ltd., Group Research and Development, Southampton, UK
| | - Erin Hill
- Institute for In Vitro Sciences, Inc., Gaithersburg, MD, USA
| | - Julia Hoeng
- Philip Morris International R&D, Philip Morris Products S.A., Neuchâtel, Switzerland
| | - A Wallace Hayes
- Institute of Integrated Toxicology, Michigan State University, East Lansing, MI, USA
- College of Public Health, University of South Florida, Tampa, FL, USA
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49
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Jaccard G, Tafin Djoko D, Moennikes O, Jeannet C, Kondylis A, Belushkin M. Comparative assessment of HPHC yields in the Tobacco Heating System THS2.2 and commercial cigarettes. Regul Toxicol Pharmacol 2017; 90:1-8. [PMID: 28818540 DOI: 10.1016/j.yrtph.2017.08.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/07/2017] [Accepted: 08/12/2017] [Indexed: 11/21/2022]
Abstract
There has been a sustained effort in recent years to develop products with the potential to present less risk compared with continued smoking as an alternative for adult smokers who would otherwise continue to smoke cigarettes. During the non-clinical assessment phase of such products, the chemical composition and toxicity of their aerosols are frequently compared to the chemical composition and toxicity of the smoke from a standard research cigarette - the 3R4F reference cigarette. In the present study, it is demonstrated that results of these analytical comparisons are similar when considering commercially available cigarette products worldwide. A market mean reduction of about 90% is observed on average across a broad range of harmful and potentially harmful constituents (HPHC) measured in the aerosol of a candidate modified risk tobacco product, the Tobacco Heating System 2.2 (THS2.2), compared against the levels of HPHC of cigarettes representative of selected markets; this mean reduction is well in line with the reduction observed against 3R4F smoke constituents in previous studies.
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Affiliation(s)
- G Jaccard
- Philip Morris International R&D, Philip Morris Products SA, Rue des Usines 56, CH-2000 Neuchâtel, Switzerland.
| | - D Tafin Djoko
- Philip Morris International R&D, Philip Morris Products SA, Rue des Usines 56, CH-2000 Neuchâtel, Switzerland
| | - O Moennikes
- Philip Morris International R&D, Philip Morris Products SA, Rue des Usines 56, CH-2000 Neuchâtel, Switzerland
| | - C Jeannet
- Philip Morris International R&D, Philip Morris Products SA, Rue des Usines 56, CH-2000 Neuchâtel, Switzerland
| | - A Kondylis
- Philip Morris International R&D, Philip Morris Products SA, Rue des Usines 56, CH-2000 Neuchâtel, Switzerland
| | - M Belushkin
- Philip Morris International R&D, Philip Morris Products SA, Rue des Usines 56, CH-2000 Neuchâtel, Switzerland
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50
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Brossard P, Weitkunat R, Poux V, Lama N, Haziza C, Picavet P, Baker G, Lüdicke F. Nicotine pharmacokinetic profiles of the Tobacco Heating System 2.2, cigarettes and nicotine gum in Japanese smokers. Regul Toxicol Pharmacol 2017; 89:193-199. [PMID: 28760390 DOI: 10.1016/j.yrtph.2017.07.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 11/18/2022]
Abstract
Two open-label randomized cross-over studies in Japanese smokers investigated the single-use nicotine pharmacokinetic profile of the Tobacco Heating System (THS) 2.2, cigarettes (CC) and nicotine replacement therapy (Gum). In each study, one on the regular and one on the menthol variants of the THS and CC, both using Gum as reference, 62 subjects were randomized to four sequences: Sequence 1: THS - CC (n = 22); Sequence 2: CC - THS (n = 22); Sequence 3: THS - Gum (n = 9); Sequence 4: Gum - THS (n = 9). Plasma nicotine concentrations were measured in 16 blood samples collected over 24 h after single use. Maximal nicotine concentration (Cmax) and area under the curve from start of product use to time of last quantifiable concentration (AUC0-last) were similar between THS and CC in both studies, with ratios varying from 88 to 104% for Cmax and from 96 to 98% for AUC0-last. Urge-to-smoke total scores were comparable between THS and CC. The THS nicotine pharmacokinetic profile was close to CC, with similar levels of urge-to-smoke. This suggests that THS can satisfy smokers and be a viable alternative to cigarettes for adult smokers who want to continue using tobacco.
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Affiliation(s)
- Patrick Brossard
- PMI R&D, Philip Morris Products S.A. (Part of Philip Morris International Group of Companies), Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Rolf Weitkunat
- PMI R&D, Philip Morris Products S.A. (Part of Philip Morris International Group of Companies), Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland.
| | - Valerie Poux
- PMI R&D, Philip Morris Products S.A. (Part of Philip Morris International Group of Companies), Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Nicola Lama
- PMI R&D, Philip Morris Products S.A. (Part of Philip Morris International Group of Companies), Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Christelle Haziza
- PMI R&D, Philip Morris Products S.A. (Part of Philip Morris International Group of Companies), Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Patrick Picavet
- PMI R&D, Philip Morris Products S.A. (Part of Philip Morris International Group of Companies), Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Gizelle Baker
- PMI R&D, Philip Morris Products S.A. (Part of Philip Morris International Group of Companies), Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
| | - Frank Lüdicke
- PMI R&D, Philip Morris Products S.A. (Part of Philip Morris International Group of Companies), Quai Jeanrenaud 5, CH-2000 Neuchâtel, Switzerland
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