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Rubaiya Talukder S, Lappin J, Clare Boland V, Weaver N, McRobbie H, James Courtney R. Mental health related adverse events of cytisine and varenicline in smokers with and without mental health disorders: Secondary analysis of a randomized controlled trial. Addict Behav 2024; 159:108148. [PMID: 39213816 DOI: 10.1016/j.addbeh.2024.108148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/25/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Little is known about the adverse events (AEs) of cytisine versus varenicline among individuals with mental health disorders (MHDs), highlighting the necessity for further exploration to inform clinical practice. This secondary analysis of clinical trial data aimed to investigate the effect of varenicline vs. cytisine regarding mental-health-related AEs (MH-related AEs) on smokers with and without MHDs. METHODS Australian daily smokers interested in quitting were randomised to varenicline (84 days) or cytisine (25 days) and categorised by self-reported MHD diagnosis or treatment in the past year (MHD or non-MHD groups). Treatment adherence was assessed by self-reported number of doses taken during the active treatment phase via two check-in calls (at one month), while AEs were evaluated through four phone interviews: two check-in calls (one month) and follow-up calls at four and seven months. Logistic regression analysis compared MH-related AEs between groups, including only participants taking at least one dose. RESULTS Of 1452 smokers 246 reported MHDs, 725 received cytisine and 727 received varenicline. Median number of doses taken was comparable between MHD (34 cytisine and 12 varenicline) and non-MHD (33 cytisine and 13 varenicline) groups. MH-related AEs were: 14.1 % (n = 30) in MHD (12.5 % in cytisine and 15.4 % in varenicline), and 11.8 % (n = 126) in non-MHD group (10.9 % in cytisine and 13.7 % in varenicline). No significant difference in MH-related AE occurrence was identified between medication groups (aOR=0.96, 95 % CI 0.4 to 2.2, p-value = 0.94). CONCLUSION Comparable MH-related AEs were observed between smokers with and without MHDs, suggesting that cytisine, like varenicline, may be well-tolerated by those with MHDs. However, larger clinical trials focused on MH-related AEs are needed for more conclusive evidence.
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Affiliation(s)
- Saki Rubaiya Talukder
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St, Randwick, New South Wales 2031, Australia.
| | - Julia Lappin
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St, Randwick, New South Wales 2031, Australia; Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney 2200, Australia
| | - Veronica Clare Boland
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St, Randwick, New South Wales 2031, Australia
| | - Natasha Weaver
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St, Randwick, New South Wales 2031, Australia
| | - Ryan James Courtney
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King St, Randwick, New South Wales 2031, Australia
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Spoelstra SK, Schoevers RA, Venema SD, Knegtering H. Psychedelics as a potential treatment for tobacco use disorder: a systematic review. DISCOVER MENTAL HEALTH 2024; 4:37. [PMID: 39289250 PMCID: PMC11408463 DOI: 10.1007/s44192-024-00095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 09/05/2024] [Indexed: 09/19/2024]
Abstract
INTRODUCTION Despite considerable efforts, tobacco use disorder persists as a significant public health issue. The effectiveness of current smoking cessation therapies is limited, leading to a growing interest in alternative treatment approaches such as psychedelics. AIM The aim of this review is to evaluate the scientific evidence regarding the role of psychedelics in smoking cessation. METHODS To identify relevant literature on psychedelics and smoking cessation, a search was conducted in four academic literature databases PubMed, MEDLINE, PsycINFO, and Embase. Databases were searched from their inception up to March 24, 2024. RESULTS Out of the 1073 articles identified in databases, 8 publications (both clinical and non-clinical studies) met the inclusion criteria, of which a total of 4 publications originated from a single study. The majority of the studies focused on psilocybin (n = 7), for which supportive evidence was suggested for the treatment of tobacco use disorder. Additionally, research was conducted with other psychedelics for smoking cessation, such as ayahuasca, mescaline, peyote, lysergic acid diethylamide (LSD), lysergic acid amide (LSA) and (dimethyltryptamine (DMT), but the evidence base for these psychedelics is too small to draw definitive conclusions. CONCLUSIONS There is, although limited, evidence that psychedelics, in particular psilocybin, may offer a potential avenue for combating tobacco use disorder, though more research is needed to understand their effectiveness and safety fully.
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Affiliation(s)
- S K Spoelstra
- Addiction Care North Netherlands, Groningen, The Netherlands.
- NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands.
| | - R A Schoevers
- University of Groningen, Groningen, The Netherlands
- University Medical Center Groningen, Groningen, The Netherlands
| | - S D Venema
- Addiction Care North Netherlands, Groningen, The Netherlands
- Hanze University of Applied Sciences, Groningen, The Netherlands
| | - H Knegtering
- University Medical Center Groningen, Groningen, The Netherlands
- Lentis, Groningen, The Netherlands
- GGZ Drenthe, Mental Healh Institution, Department of Psychotic Ilnesses, Assen, The Netherlands
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Cinciripini PM. Subsequent Smoking Cessation Treatment After Varenicline or Nicotine Replacement-Reply. JAMA 2024:2823415. [PMID: 39250130 DOI: 10.1001/jama.2024.15506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Affiliation(s)
- Paul M Cinciripini
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston
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Foo CYS, Potter K, Nielsen L, Rohila A, Maravic MC, Schnitzer K, Pachas GN, Levy DE, Reyering S, Thorndike AN, Cather C, Evins AE. Implementation of Community Health Worker Support for Tobacco Cessation: A Mixed-Methods Study. Psychiatr Serv 2024:appips20240044. [PMID: 39118574 DOI: 10.1176/appi.ps.20240044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
OBJECTIVE Adults with serious mental illness have high rates of tobacco use disorder and underuse pharmacotherapy for tobacco cessation. In a previous randomized controlled trial, participants receiving community health worker (CHW) support and education for their primary care providers (PCPs) had higher tobacco abstinence rates at 2 years, partly because of increased initiation of tobacco-cessation pharmacotherapy. The authors aimed to determine the association between CHW-participant engagement and tobacco abstinence outcomes. METHODS The authors conducted a secondary, mixed-methods analysis of 196 participants in the trial's intervention arm. Effects of the number and duration of CHW visits, number of smoking-cessation group sessions attended, and number of CHW-attended PCP visits on initiation of tobacco-cessation pharmacotherapy and tobacco abstinence were modeled via logistic regression. Interviews with 12 CHWs, 17 patient participants, and 17 PCPs were analyzed thematically. RESULTS Year 2 tobacco abstinence was significantly associated with CHW visit number (OR=1.85, 95% CI=1.29-2.66), visit duration (OR=1.51, 95% CI=1.00-2.28), and number of group sessions attended (OR=1.85, 95% CI=1.33-2.58); effects on pharmacotherapy initiation were similar. One to three CHW visits per month across 2 years were optimal for achieving abstinence. Interviews identified CHW-patient engagement facilitators (i.e., trust, goal accountability, skills reinforcement, assistance in overcoming barriers to treatment access, and adherence). Training and supervision facilitated CHW effectiveness; barriers included PCPs' and care teams' limited understanding of the CHW role. CONCLUSIONS Greater CHW-participant engagement, within feasible dose ranges, was associated with tobacco abstinence among adults with serious mental illness. Implementation of CHW interventions may benefit from further CHW training and integration within clinical teams.
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Affiliation(s)
- Cheryl Y S Foo
- Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Cather, Evins) and Medicine (Levy, Thorndike), Harvard Medical School, Boston; Bay Cove Human Services, Boston (Reyering)
| | - Kevin Potter
- Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Cather, Evins) and Medicine (Levy, Thorndike), Harvard Medical School, Boston; Bay Cove Human Services, Boston (Reyering)
| | - Lindsay Nielsen
- Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Cather, Evins) and Medicine (Levy, Thorndike), Harvard Medical School, Boston; Bay Cove Human Services, Boston (Reyering)
| | - Aarushi Rohila
- Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Cather, Evins) and Medicine (Levy, Thorndike), Harvard Medical School, Boston; Bay Cove Human Services, Boston (Reyering)
| | - Melissa Culhane Maravic
- Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Cather, Evins) and Medicine (Levy, Thorndike), Harvard Medical School, Boston; Bay Cove Human Services, Boston (Reyering)
| | - Kristina Schnitzer
- Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Cather, Evins) and Medicine (Levy, Thorndike), Harvard Medical School, Boston; Bay Cove Human Services, Boston (Reyering)
| | - Gladys N Pachas
- Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Cather, Evins) and Medicine (Levy, Thorndike), Harvard Medical School, Boston; Bay Cove Human Services, Boston (Reyering)
| | - Douglas E Levy
- Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Cather, Evins) and Medicine (Levy, Thorndike), Harvard Medical School, Boston; Bay Cove Human Services, Boston (Reyering)
| | - Sally Reyering
- Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Cather, Evins) and Medicine (Levy, Thorndike), Harvard Medical School, Boston; Bay Cove Human Services, Boston (Reyering)
| | - Anne N Thorndike
- Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Cather, Evins) and Medicine (Levy, Thorndike), Harvard Medical School, Boston; Bay Cove Human Services, Boston (Reyering)
| | - Corinne Cather
- Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Cather, Evins) and Medicine (Levy, Thorndike), Harvard Medical School, Boston; Bay Cove Human Services, Boston (Reyering)
| | - A Eden Evins
- Department of Psychiatry (Foo, Potter, Nielsen, Rohila, Maravic, Schnitzer, Pachas, Cather, Evins), Mongan Institute Health Policy Research Center (Levy), and Division of General Internal Medicine (Thorndike), Massachusetts General Hospital, Boston; Departments of Psychiatry (Foo, Potter, Pachas, Cather, Evins) and Medicine (Levy, Thorndike), Harvard Medical School, Boston; Bay Cove Human Services, Boston (Reyering)
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Fucito LM, Baldassarri SR, Baker NL, Palmer AM, O'Malley SS, Carpenter MJ, Krishnan-Sarin S, Gray KM, Toll BA. Varenicline for E-Cigarette Cessation in Adults: A Preliminary Placebo-Controlled Randomized Trial. Am J Prev Med 2024; 67:296-298. [PMID: 38752949 PMCID: PMC11260542 DOI: 10.1016/j.amepre.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 07/22/2024]
Affiliation(s)
- Lisa M Fucito
- Department of Psychiatry, Yale School of Medicine, New Haven, CT; Yale Cancer Center, Yale School of Medicine, New Haven, CT.
| | - Stephen R Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care & Sleep Medicine, Yale University School of Medicine, New Haven, CT
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | | | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | | | - Kevin M Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Benjamin A Toll
- Department of Psychiatry, Yale School of Medicine, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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6
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Tuisku A, Rahkola M, Nieminen P, Toljamo T. Electronic Cigarettes vs Varenicline for Smoking Cessation in Adults: A Randomized Clinical Trial. JAMA Intern Med 2024; 184:915-921. [PMID: 38884987 PMCID: PMC11184496 DOI: 10.1001/jamainternmed.2024.1822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/30/2024] [Indexed: 06/18/2024]
Abstract
Importance Little is known about the relative effectiveness of nicotine-containing electronic cigarettes (ECs) compared with varenicline as smoking cessation aids. Objective To determine the relative effectiveness of ECs in smoking cessation. Design, Setting, and Participants This randomized placebo-controlled single-center trial was conducted in northern Finland. Participants aged 25 to 75 years who smoked daily and had volunteered to quit smoking were recruited from August 1, 2018, to February 20, 2020, via local media. The trial included 52 weeks of follow-up. All data analyses were conducted from September 1, 2022, to January 15, 2024. The participants, study nurses, and researchers were masked to group assignment. Intervention The participants were assigned by block randomization to receive 18 mg/mL of nicotine-containing ECs together with placebo tablets, varenicline with standard dosing together with nicotine-free ECs, or placebo tablets together with nicotine-free ECs, all combined with a motivational interview, with the intervention phase lasting for 12 weeks. Main Outcome and Measure The primary outcome was self-reported 7-day conventional cigarette smoking abstinence as confirmed by the exhaled carbon monoxide level on week 26. The analysis followed the intent-to-treat principle. Results Of the 561 recruited participants, 458 (81.6%) eligible participants (257 women [56%]; 201 men [44%]; mean [SD] age, 51 [11.6] years) were randomized. The primary outcome occurred in 61 of 152 participants (40.4%) in the EC group, 67 of 153 (43.8%) in the varenicline group, and 30 of 153 (19.7%) in the placebo group (P < .001). In the pairwise comparison, placebo differed statistically significantly from ECs (risk difference [RD], 20.7%; 95% CI, 10.4-30.4; P < .001) and varenicline (RD, 24.1%; 95% CI, 13.7-33.7; P < .001), but the difference was statistically insignificant between ECs and varenicline (RD, 3.4%; 95% CI, -7.6 to 14.3; P = .56). No serious adverse events were reported. Conclusions This randomized clinical trial found that varenicline and nicotine-containing ECs were both effective in helping individuals in quitting smoking conventional cigarettes for up to 6 months. Trial Registration ClinicalTrials.gov Identifier: NCT03235505.
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Affiliation(s)
- Anna Tuisku
- Department of Medicine, Lapland Central Hospital, Rovaniemi, Finland
| | - Mikko Rahkola
- Institute of Clinical Medicine, University of Oulu and Department of Internal Medicine Division Oulu University Hospital, Oulu, Finland
| | - Pentti Nieminen
- Medical Informatics and Data Analysis Research Group, University of Oulu, Oulu, Finland
| | - Tuula Toljamo
- Department of Medicine, Lapland Central Hospital, Rovaniemi, Finland
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7
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Chaisai C, Patikorn C, Thavorn K, Lee SWH, Chaiyakunapruk N, Veettil SK. Incremental net monetary benefit of using varenicline for smoking cessation: A systematic review and meta-analysis of economic evaluation studies. Addiction 2024; 119:1188-1202. [PMID: 38520121 DOI: 10.1111/add.16464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 01/25/2024] [Indexed: 03/25/2024]
Abstract
AIMS To conduct a systematic review and meta-analysis and pool the incremental net benefits (INBs) of varenicline compared with behaviour support with bupropion or nicotine replacement therapy (NRT), behaviour support alone and unaided cessation in adult smokers making a first-time attempt to quit. METHODS A search for economic evaluation studies was conducted from inception to 30 September 2022, on PubMed, Embase, Cost-Effectiveness Analysis (CEA) Registry by Tufts Medical Centre, EconLit and the NHS Economic Evaluation Database (NHS EED). Eligible studies were included if they were (1) conducted among adults ages 18 years old and older who were smokers attempting to quit for the first time; (2) compared varenicline to behaviour support with bupropion or NRT, behaviour support alone and unaided cessation; and (3) performed a CEA or cost-utility analysis. The INBs were calculated and pooled across studies stratified by country income level and study perspective using the random-effects model. Statistical heterogeneity between studies was assessed using the I2 statistic and Cochrane Q statistic. RESULTS Of the 1433 identified studies, 18 studies were included in our review. Our findings from healthcare system/payer perspective suggested that the use of varenicline is statistically significantly cost-effective compared with bupropion (pooled INB, $830.75 [95% confidence interval, $208.23, $1453.28]), NRTs ($636.16 [$192.48, $1079.84]) and unaided cessation ($4212.35 [$1755.79, $6668.92]) in high-income countries. Similarly, varenicline is also found to be cost-effective compared to bupropion ($2706.27 [$1284.44, $4128.11]), NRTs ($3310.01 [$1781.53, $4838.50]) and behavioural support alone ($5438.22 [$4105.99, $6770.46]) in low- and middle-income countries. CONCLUSION Varenicline is cost-effective as a smoking cessation aid when compared with behavioural support with bupropion or nicotine replacement therapies and behavioural support alone in both high-income countries and low- and middle-income countries, from the healthcare system/payer perspective in adult smokers who attempt to quit for the first time.
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Affiliation(s)
- Chayutthaphong Chaisai
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Chanthawat Patikorn
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Kednapa Thavorn
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- School of Medicine, Taylor's University, Selangor, Malaysia
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
- IDEAS Centre, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Sajesh K Veettil
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, USA
- School of Medicine, Taylor's University, Selangor, Malaysia
- School of Pharmacy, Department of Pharmacy Practice, International Medical University, Kuala Lumpur, Malaysia
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Khan Z, Harris JR, Dearden L, Strait M, Treend K, Glesmann H, Carlini BH. Trends in varenicline use for tobacco cessation, and their implications. J Am Pharm Assoc (2003) 2024; 64:102102. [PMID: 38649095 DOI: 10.1016/j.japh.2024.102102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Tobacco use remains a leading cause of death in the U.S. Varenicline is a preferred medication for tobacco cessation, and a prior report in the literature showed its use fell dramatically after the voluntary recall of Chantix (brand) varenicline (name) in July 2021. OBJECTIVES Working with data on prescriptions for varenicline and nicotine-replacement therapy (NRT), we studied use from 2018 to 2023 to determine if varenicline use had recovered or if there had been a compensatory increase in NRT use. METHODS Data are yearly from state employees and their dependents who were ≥18 years of age and were health-insurance beneficiaries of the Washington Public Employees Benefits Board from July 2018 through June 2023. Data include numbers of tobacco users and numbers of prescriptions filled. RESULTS The 5-year prevalence of tobacco use among 224,816 beneficiaries was 4.6%. The percentage of tobacco users who filled a prescription for varenicline fell from highs of 9.5% and 9.6% in the 2018-2019 and 2019-2020 years to lows of 5.3% and 6.4% in the 2021-2022 and 2022-2023 years. For nicotine replacement therapy, prescriptions rose modestly over the 5 years, from 4.5% in 2018-2019% to 6.0% in 2022-2023. DISCUSSION Varenicline use dropped after the voluntary recall of Chantix by Pfizer in mid-2021 and has not returned to prerecall levels. CONCLUSION Pharmacists and other clinicians should address this drop, in addition to addressing longer-term challenges to increasing varenicline use; these include the requirement for a prescription and the black-box warning by the Food and Drug Administration, rescinded in 2016.
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Jackson SE, Brown J, Tattan-Birch H, Shahab L. Impact of the disruption in supply of varenicline since 2021 on smoking cessation in England: A population study. Addiction 2024; 119:1203-1210. [PMID: 38688323 DOI: 10.1111/add.16485] [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: 10/20/2023] [Accepted: 02/26/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND AND AIMS Varenicline is one of the most effective smoking cessation treatments. Its supply in England was disrupted in July 2021 due to nitrosamine impurities found by its supplier, Pfizer. This study measured the impact of this disruption on smoking cessation in England. DESIGN, SETTING AND PARTICIPANTS The study used repeated cross-sectional surveys conducted monthly, from June 2018 to December 2022. Set in England, it comprised a total of 3024 adults who reported smoking during the past year and had made at least one serious attempt to quit in the past 6 months. MEASUREMENTS Generalized additive models analyzed the association of the varenicline supply disruption with the trend in self-reported varenicline use in the most recent quit attempt. We used these results to estimate the population-level impact of the disruption on smoking cessation. FINDINGS Before July 2021, the proportion of past 6-month quit attempts using varenicline was stable at approximately 3.9% [risk ratio (RR)trend = 1.034, 95% confidence interval (CI) = 0.823-1.298]. The trend in varenicline use has changed sharply since the supply disruption (RRΔtrend = 0.297, 95% CI = 0.120-0.738), with prevalence falling by 69.3% per year since; from 4.1% in June 2021 to 0.8% in December 2022. Convergently, National Health Service general practitioner prescribing data reported that just 0.1% of prescriptions for smoking cessation treatments in December 2022 were for varenicline. Assuming that varenicline does not return to the market, we estimate that this could result in ~8400 fewer people stopping smoking for at least 6 months, ~4200 fewer long-term ex-smokers and ~1890 more avoidable deaths each year. CONCLUSIONS In England, the disruption in supply of varenicline since 2021 has coincided with a substantial fall in the use of varenicline in attempts to quit smoking.
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Affiliation(s)
- Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Harry Tattan-Birch
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, Edinburgh, UK
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10
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Robinson LE, Didier N, Thomas R, Vena A, King A. Combination Treatment With Varenicline and Nicotine Patch on Smoking Cessation Outcomes in Heavy Drinkers at 26-Week Follow-up. J Clin Psychopharmacol 2024; 44:362-368. [PMID: 38752924 PMCID: PMC11211054 DOI: 10.1097/jcp.0000000000001864] [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] [Indexed: 06/28/2024]
Abstract
PURPOSE/BACKGROUND People who smoke cigarettes and drink alcohol heavily are less likely to quit smoking compared with those who do not drink heavily. The current study examined the effects of a 12-week treatment phase of combination varenicline and nicotine patch compared with placebo and nicotine patch on smoking cessation (primary outcome) and alcohol consumption (secondary outcome) in heavy drinking smokers at 26-week follow-up. METHODS/PROCEDURES Participants were daily smokers who met heavy drinking criteria. They were randomly assigned to receive either varenicline and nicotine patch (n = 61) or placebo and nicotine patch (n = 61) for 12 weeks. At week 26, self-reports of point prevalence cigarette abstinence were biochemically confirmed, and past-month alcohol drinking days and heavy drinking days were assessed. FINDINGS/RESULTS At week 26, smoking quit rates did not differ by treatment group (25% varenicline and 26% placebo). Relative to week 12 outcomes, week 26 quit rates significantly dropped off in the varenicline group but not in the placebo group. Alcohol drinking reductions for the whole sample that were previously observed from baseline to week 12 were sustained at week 26, although they did not differ between treatment groups. IMPLICATIONS/CONCLUSIONS In heavy drinking smokers, smoking cessation success was evident in a quarter of the total sample at 3 months postmedication discontinuation. At this time, quit rates were the same between those who received varenicline and nicotine patch and those who received nicotine patch alone. Future research is warranted to examine what may aid in longer-term smoking quit rates in heavy drinking smokers.
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Affiliation(s)
- Layne E Robinson
- From the Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago IL
| | - Nathan Didier
- From the Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago IL
| | - Riya Thomas
- From the Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago IL
| | | | - Andrea King
- From the Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago IL
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Nolan MT, Ngo DTM, Sverdlov AL. How to build an actionable narrative for cardio-oncology. Trends Cardiovasc Med 2024:S1050-1738(24)00054-9. [PMID: 38950663 DOI: 10.1016/j.tcm.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 06/24/2024] [Indexed: 07/03/2024]
Affiliation(s)
- Mark T Nolan
- Department of Cardiovascular Imaging, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Doan T M Ngo
- Newcastle Centre of Excellence in Cardio-Oncology, University of Newcastle, Hunter New England Local Health District, Calvary Mater Newcastle, Hunter Medical Research institute, New Lambton Heights, NSW 2305, Australia; College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Aaron L Sverdlov
- Newcastle Centre of Excellence in Cardio-Oncology, University of Newcastle, Hunter New England Local Health District, Calvary Mater Newcastle, Hunter Medical Research institute, New Lambton Heights, NSW 2305, Australia; Cardiovascular Department, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia; College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia.
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Mantey DS, Hebert ET, Clendennen SL, Kelder SH, Harrell MB. Commentary Regarding "Adult Smokers' Complete Switching Away from Cigarettes at 6, 9, and 12 Months After Initially Purchasing a JUUL e-Cigarette". Subst Use Misuse 2024; 59:1660-1662. [PMID: 38898556 DOI: 10.1080/10826084.2024.2360662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Affiliation(s)
- Dale S Mantey
- Department of Health Promotion and Behavioral Science, University of Texas School of Public Health, Austin, Texas, USA
- Department of Epidemiology, University of Texas School of Public Health, Houston, Texas, USA
| | - Emily T Hebert
- Department of Health Promotion and Behavioral Science, University of Texas School of Public Health, Austin, Texas, USA
| | - Stephanie L Clendennen
- Department of Health Promotion and Behavioral Science, University of Texas School of Public Health, Austin, Texas, USA
| | - Steven H Kelder
- Department of Epidemiology, University of Texas School of Public Health, Houston, Texas, USA
| | - Melissa B Harrell
- Department of Epidemiology, University of Texas School of Public Health, Houston, Texas, USA
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Bellini BB, Scholz JR, Abe TO, Arnaut D, Tonstad S, Alberto RL, Gaya PV, de Moraes IRA, Teixeira MJ, Marcolin MA. Does deep TMS really works for smoking cessation? A prospective, double blind, randomized, sham controlled study. Prog Neuropsychopharmacol Biol Psychiatry 2024; 132:110997. [PMID: 38531486 DOI: 10.1016/j.pnpbp.2024.110997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/27/2024] [Accepted: 03/23/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION A substantial proportion of smokers wishing to quit do not stop smoking when using current therapies to aid cessation. Magnetic pulses to specific brain areas designated as transcranial magnetic stimulation may modulate brain activity and thereby change chemical dependencies. Deep transcranial magnetic stimulation (dTMS) with the H4 coil stimulates neuronal pathways in the lateral prefrontal cortex and insula bilaterally, areas involved in tobacco addiction. OBJECTIVE To evaluate the efficacy and safety of dTMS with T4 coil in smoking cessation. METHODS In a double blind, controlled clinical trial, adult smokers of at least 10 cigarettes/day were randomized to active (n = 50) versus sham dTMS (n = 50). The protocol involved up to 21 sessions administered over up to 12 weeks. Tobacco use was monitored by self-report and confirmed by expired air monoximetry (at each dTMS visit) and blood cotinine (at the screening visit and at the end of sessions). Participants completed abstinence, mood and cognition scales at determined timepoints during follow-up. RESULTS In the intention to-treat-analysis, the cessation rate of the intervention and control groups was 14.0%. The reported side effects were as expected for this procedure. Although there were no serious adverse events, three participants were withdrawn according to safety criteria. CONCLUSION Active treatment with dTMS H4 coil was safe but not effective for smoking cessation.
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Affiliation(s)
- Bianca B Bellini
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil; Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil.
| | - Jaqueline R Scholz
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Tania O Abe
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Debora Arnaut
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Serena Tonstad
- Department of Preventive Cardiology, Oslo University Hospital, Oslo, Norway
| | - Rodrigo L Alberto
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Patricia V Gaya
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Iana R A de Moraes
- Department of Preventive Medicine- Smoking Cessation Program, Incor (Heart Institute), Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Manoel J Teixeira
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Marco A Marcolin
- Neurology Department of Clinical Hospital, University of Sao Paulo, Sao Paulo, Brazil
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Kim S, Shiffman S, Goldenson NI. Reply to Commentary on "Adult Smokers' Complete Switching Away from Cigarettes at 6, 9, and 12 Months After Initially Purchasing a JUUL e-Cigarette" and the Adult JUUL Switching and Smoking Trajectories (ADJUSST) Study. Subst Use Misuse 2024; 59:1663-1666. [PMID: 38826103 DOI: 10.1080/10826084.2024.2360667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
BACKGROUND This is authors' reply to the Commentary on our publication entitled "Adult smokers' Complete Switching Away from Cigarettes at 6, 9, and 12 Months after Initially Purchasing a JUUL e-Cigarette." METHODS AND RESULTS Analyses addressed questions about follow-up rates and missed responses in the Adult JUUL Switching and Smoking Trajectories (ADJUSST) Study. Results demonstrate limited potential for selection bias, as participants who missed surveys were similar to those with complete data, and re-contact of participants who missed a follow-up indicated almost half were not smoking. Imputing smoking behavior for missing data would likely introduce bias and is not appropriate. The study demonstrated that JUUL products can facilitate high rates of complete switching away from cigarettes as suggested in previous experimental and observational studies. The ADJUSST cohort, including baseline nonsmokers, demonstrates a net reduction in smoking prevalence. Moreover, population modeling considering both benefits and harms demonstrated a net population benefit. CONCLUSION While the ADJUSST Study is not without limitations, the findings are consistent with multiple streams of real-world evidence that indicate that ENDS can facilitate switching among adults who smoke, and provide population benefits.
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Cruvinel E, Mussulman L, Scheuermann T, Shergina E, He J, Sherman S, Harrington K, Rigotti NA, Tindle H, Zhu SH, Richter K. Hospital-Initiated Smoking Cessation Among Patients Admitted with Behavioral Health Conditions. J Gen Intern Med 2024; 39:1423-1430. [PMID: 38326585 PMCID: PMC11169289 DOI: 10.1007/s11606-024-08646-5] [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: 09/08/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Smoking rates among people living with behavioral health conditions (BHC) range from 30 to 65% and are 2-4 times higher than rates found in the general population. Starting tobacco treatment during a hospital stay is effective for smoking cessation, but little is known regarding treatment response among inpatients with BHC. OBJECTIVE This study pooled data across multiple clinical trials to determine the relative success in quitting among participants with BHC compared to other study participants. PARTICIPANTS Adults who smoke (≥ 18 years old) from five hospital-based smoking cessation randomized clinical trials. DESIGN A retrospective analysis using data from the electronic health record to identify participants with primary diagnoses related to BHC. Recruitment and data analysis were conducted from 2011 to 2016. We used propensity score matching to pair patients with BHC to those with similar characteristics and logistic regression to determine differences between groups. MEASURES The main outcome was self-reported 30-day abstinence 6 months post-discharge. RESULTS Of 6612 participants, 798 patients had a BHC-related primary diagnosis. The matched sample included 642 pairs. Nearly 1 in 3 reported using tobacco medications after hospitalization, with no significant difference between patients with and without BHC (29.3% vs. 31.5%; OR (95% CI) = 0.90 (0.71, 1.14), p = 0.40). Nearly 1 in 5 patients with BHC reported abstinence at 6 months; however, their odds of abstinence were 30% lower than among people without BHC (OR (95% CI) = 0.70 (0.53,0.92), p = 0.01). CONCLUSION When offered tobacco treatment, hospitalized patients with BHC were as likely as people without BHC to accept and engage in treatment. However, patients with BHC were less likely to report abstinence compared to those without BHC. Hospitals are a feasible and promising venue for tobacco treatment among inpatients with BHC. More studies are needed to identify treatment approaches that help people with BHC achieve long-term abstinence.
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Affiliation(s)
- Erica Cruvinel
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Laura Mussulman
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Taneisha Scheuermann
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Elena Shergina
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jianghua He
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Scott Sherman
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Kathleen Harrington
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nancy A Rigotti
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Hilary Tindle
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Shu-Hong Zhu
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Kimber Richter
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
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Ali MR, Nacer H, Lawson CA, Khunti K. Racial and Ethnic Disparities in Primary Prevention of Cardiovascular Disease. Can J Cardiol 2024; 40:1016-1030. [PMID: 38309463 DOI: 10.1016/j.cjca.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 02/05/2024] Open
Abstract
Cardiovascular disease (CVD) disproportionately affects ethnic-minority groups globally. Ethnic-minority groups face particularly high CVD burden and mortality, exacerbated by disparities across modifiable risk factors, wider determinants of health, and limited access to preventative interventions. This narrative review summarizes evidence on modifiable risk factors, such as physical activity, hypertension, diet, smoking, alcohol consumption, diabetes, and the polypill for the primary prevention of CVD in ethnic minorities. Across these factors, we find inequities in risk factor prevalence. The evidence underscores that inequalities in accessibility to interventions and treatments impede progress in reducing CVD risk using primary prevention interventions for ethnic-minority people. Although culturally tailored interventions show promise, further research is required across the different risk factors. Social determinants of health and structural inequities also exacerbate CVD risk for ethnic-minority people and warrant greater attention. Additionally, we find that only limited ethnicity-specific data and guidelines are available on CVD primary prevention interventions for most risk factors. To address these gaps in research, we provide recommendations that include the following: investigating the sustainability and real-world effectiveness of culturally sensitive interventions; ensuring that ethnic-minority peoples' perspectives are considered in research; longitudinal tracking of risk factors; interventions and outcomes in ethnic-minority people; and ensuring that data collection and reporting of ethnicity data are standardized.
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Affiliation(s)
- Mohammad R Ali
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; National Institute for Health Research (NIHR) Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom; Diabetes Research Centre, University of Leicester, Leicester, United Kingdom.
| | | | - Claire A Lawson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; National Institute for Health Research (NIHR) Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom; National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands, University of Leicester, Leicester, United Kingdom
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Gaalema DE, Allencherril J, Khadanga S, Klemperer E. Differential effects of cigarette smoking on cardiovascular disease in females: A narrative review and call to action. Prev Med 2024:108013. [PMID: 38815766 DOI: 10.1016/j.ypmed.2024.108013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/23/2024] [Accepted: 05/26/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE Cigarette smoking continues to be a major driver in the incidence and progression of cardiovascular disease (CVD). As females become an increasingly larger fraction of those who smoke it is imperative that the sex-specific effects of smoking be further explored and acted upon. METHODS This narrative review describes current evidence on the differential effects of smoking on CVD in females and the need to improve treatment. RESULTS Evidence to date suggests that smoking has disproportionately negative effects on the cardiovascular (CV) system in females, especially in those who are younger. Usually, the onset of CVD is later in females than males, but smoking decreases or eliminates this gap. Females are also more likely to develop types of CVD closely tied to smoking, such as ST-elevated myocardial infarctions, with even higher rates among those who are younger. Possible mechanisms for these worse outcomes in females include a complex interplay between nicotine, other products of combusted cigarettes, and hormones. Sex differences also exist in treatment for smoking. In females, Varenicline appears more effective than either Bupropion or nicotine replacement therapy while in males, all three therapies show similar efficacy. Disparities in smoking are also apparent in secondary prevention settings. Females and males are entering secondary prevention with equal rates of smoking, with potentially higher levels of exposure to the byproducts of smoking in females. CONCLUSIONS These disproportionately negative outcomes for females who smoke require additional research and these persisting rates of smoking suggest a need for female-specific approaches for treating smoking.
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Meng Y, Xiang S, Qu L, Li Y. The efficacy and acceptability of pharmacological monotherapies and e-cigarette on smoking cessation: a systemic review and network meta-analysis. Front Public Health 2024; 12:1361186. [PMID: 38841681 PMCID: PMC11150810 DOI: 10.3389/fpubh.2024.1361186] [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: 12/25/2023] [Accepted: 05/03/2024] [Indexed: 06/07/2024] Open
Abstract
Background and aims Several pharmacological interventions, such as nicotine replacement therapy (NRT), varenicline, and bupropion, have been approved for clinical use of smoking cessation. E-cigarettes (EC) are increasingly explored by many RCTs for their potentiality in smoking cessation. In addition, some RCTs are attempting to explore new drugs for smoking cessation, such as cytisine. This network meta-analysis (NMA) aims to investigate how these drugs and e-cigarettes compare regarding their efficacy and acceptability. Materials and methods This systematic review and NMA searched all clinical studies on smoking cessation using pharmacological monotherapies or e-cigarettes published from January 2011 to May 2022 using MEDLINE, COCHRANE Library, and PsychINFO databases. NRTs were divided into transdermal (TDN) and oronasal nicotine (ONN) by administrative routes, thus 7 network nodes were set up for direct and indirect comparison. Two different indicators measured the efficacy: prevalent and continuous smoking abstinence. The drop-out rates measured the acceptability. Results The final 40 clinical studies included in this study comprised 77 study cohorts and 25,889 participants. Varenicline is more effective intervention to assist in smoking cessation during 16-32 weeks follow-up, and is very likely to prompt dropout. Cytisine shows more effectiveness in continuous smoking cessation but may also lead to dropout. E-cigarettes and oronasal nicotine are more effective than no treatment in encouraging prevalent abstinence, but least likely to prompt dropout. Finally, transdermal nicotine delivery is more effective than no treatment in continuous abstinence, with neither significant effect on prevalent abstinence nor dropout rate. Conclusion This review suggested and agreed that Varenicline, Cytisine and transdermal nicotine delivery, as smoking cessation intervention, have advantages and disadvantages. However, we had to have reservations about e-cigarettes as a way to quit smoking in adolescents.
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Affiliation(s)
- Yajing Meng
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Sike Xiang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Lang Qu
- Department of Medicine, Sinai Hospital of Baltimore, Baltimore, MD, United States
| | - Ying Li
- Department of Cardiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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Leutwyler H, Hubbard E, Humfleet G, Souza R, Balestra D, Wallhagen M. The Whole Package: A Multi-Component Smoking Cessation Intervention for Adults With Serious Mental Illness: A Qualitative Study. Tob Use Insights 2024; 17:1179173X241253229. [PMID: 38779493 PMCID: PMC11110503 DOI: 10.1177/1179173x241253229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction: Smoking is one of the most important modifiable risk factors for excess morbidity and mortality in adults with serious mental illness (SMI). Many smokers with SMI are reportedly motivated to quit, however success rates among these smokers remain low and evidence-based treatment targeting this vulnerable group is limited. The purpose of this paper is to report the results of a qualitative inquiry of participants. Methods: We conducted a pilot two-arm randomized controlled trial (RCT) targeting adults with SMI. Our smoking cessation intervention included: (a) group-based physical activity (PA) game intervention (50 minutes, 3X/week for 12 weeks), (b) pharmacotherapy (bupropion or nicotine replacement therapy), and (c) smoking cessation counseling. Upon completion of the program, participants in the active and control groups completed a qualitative semi-structured interview in order to determine how the program impacted their smoking cessation. Grounded Theory methodology guided our data collection and analysis. Results: Twenty participants completed an interview. Participants described how the "whole package" of the 3 components of the intervention were critical to their smoking cessation process. The group-based program provided the structure, resources, and encouragement needed to start the process of quitting. Conclusion: Adults with SMI need support, resources, and engaging activities as they begin quitting and practice the skills needed to quit.
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Affiliation(s)
- Heather Leutwyler
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
| | - Erin Hubbard
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
| | - Gary Humfleet
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Richard Souza
- Department of Physical Therapy and Rehabilitation Sciences, University of California, San Francisco, CA, USA
| | - Dennys Balestra
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
| | - Margaret Wallhagen
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
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Atiq MA, Baker MR, Voort JLV, Vargas MV, Choi DS. Disentangling the acute subjective effects of classic psychedelics from their enduring therapeutic properties. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06599-5. [PMID: 38743110 DOI: 10.1007/s00213-024-06599-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
Recent research with classic psychedelics suggests significant therapeutic potential, particularly for neuropsychiatric disorders. A mediating influence behind symptom resolution is thought to be the personal insight - at times, bordering on the mystical - one acquires during the acute phase of a psychedelic session. Indeed, current clinical trials have found strong correlations between the acute subjective effects (ASE) under the influence of psychedelics and their enduring therapeutic properties. However, with potential barriers to widespread clinical implementation, including the healthcare resource-intensive nature of psychedelic sessions and the exclusion of certain at-risk patient groups, there is an active search to determine whether ASE elimination can be accompanied by the retention of persisting therapeutic benefits of these class of compounds. Recognizing the aberrant underlying neural circuitry that characterizes a range of neuropsychiatric disorders, and that classic psychedelics promote neuroplastic changes that may correct abnormal circuitry, investigators are rushing to design and discover compounds with psychoplastogenic, but not hallucinogenic (i.e., ASE), therapeutic potential. These efforts have paved the discovery of 'non-psychedelic/subjective psychedelics', or compounds that lack hallucinogenic activity but with therapeutic efficacy in preclinical models. This review aims to distill the current evidence - both clinical and preclinical - surrounding the question: can the ASE of classic psychedelics be dissociated from their sustained therapeutic properties? Several plausible clinical scenarios are then proposed to offer clarity on and potentially answer this question.
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Affiliation(s)
- Mazen A Atiq
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
| | - Matthew R Baker
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Jennifer L Vande Voort
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Maxemiliano V Vargas
- Institute for Psychedelics and Neurotherapeutics, University of California, Davis, Davis, CA, USA
| | - Doo-Sup Choi
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
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Parro-Torres C, Casas M, Martínez-Raga J, Pinet Ogué MC, Sáiz Martínez PA, Szerman N. Tobacco use disorder and other mental disorders: The neglected dual disorder. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2024:S2950-2853(24)00029-2. [PMID: 38740329 DOI: 10.1016/j.sjpmh.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Carlos Parro-Torres
- Institute of Psychiatry and Mental Health, Gregorio Marañón University General Hospital, Madrid, Spain.
| | - Miquel Casas
- Institut MIND, Hospital Sant Joan de Déu, Barcelona, Spain
| | - José Martínez-Raga
- Department of Psychiatry and Clinical Psychology, Hospital Universitario Doctor Peset, University of Valencia, Valencia, Spain
| | - Ma Cristina Pinet Ogué
- Addictive Behavior Unit, Psychiatry Department, Hospital de la Santa Creu i Sant Pau, Campus Salut, Barcelona, Spain
| | - Pilar Alejandra Sáiz Martínez
- Department of Psychiatry, Universidad de Oviedo, Oviedo, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM)-Instituto de Salud Carlos III, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain; Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
| | - Néstor Szerman
- Institute of Psychiatry and Mental Health, Gregorio Marañón University General Hospital, Madrid, Spain
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Bada F, Mansfield ME, Okui L, Montebatsi M, DiClemente C, Tapera R, Ikgopoleng K, Mokonopi S, Magidson JF, Onukwugha E, Ndwapi N, Himelhoch S, Mbongwe B, Charurat M. Design and rationale of the Botswana Smoking Abstinence Reinforcement Trial: a protocol for a stepped-wedge cluster randomized trial. Implement Sci Commun 2024; 5:53. [PMID: 38720363 PMCID: PMC11077839 DOI: 10.1186/s43058-024-00588-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND With expanded and sustained availability of HIV treatment resulting in substantial improvements in life expectancy, the need to address modifiable risk factors associated with leading causes of death among people living with HIV/AIDS (PLWH), such as tobacco smoking, has increased. Tobacco use is highly prevalent among PLWH, especially in southern Africa, where HIV is heavily concentrated, and many people who smoke would like to quit but are unable to do so without assistance. SBIRT (Screening, Brief Intervention and Referral to Treatment) is a well-established evidence-based approach successful at supporting smoking cessation in a variety of settings. Varenicline is efficacious in supporting smoking cessation. We intend to assess the effectiveness of SBIRT and varenicline on smoking cessation among PLWH in Botswana and the effectiveness of our implementation. METHODS BSMART (Botswana Smoking Abstinence Reinforcement Trial) is a stepped-wedge, cluster randomized, hybrid Type 2 effectiveness-implementation study guided by the RE-AIM framework, to evaluate the effectiveness and implementation of an SBIRT intervention consisting of the 5As compared to an enhanced standard of care. SBIRT will be delivered by trained lay health workers (LHWs), followed by referral to treatment with varenicline prescribed and monitored by trained nurse prescribers in a network of outpatient HIV care facilities. Seven hundred and fifty people living with HIV who smoke daily and have been receiving HIV care and treatment at one of 15 health facilities will be recruited if they are up to 18 years of age and willing to provide informed consent to participate in the study. DISCUSSION BSMART tests a scalable approach to achieve and sustain smoking abstinence implemented in a sustainable way. Integrating an evidence-based approach such as SBIRT, into an HIV care system presents an important opportunity to establish and evaluate a modifiable cancer prevention strategy in a middle-income country (MIC) setting where both LHW and non-physician clinicians are widely used. The findings, including the preliminary cost-effectiveness, will provide evidence to guide the Botswanan government and similar countries as they strive to provide affordable smoking cessation support at scale. CLINICAL TRIAL REGISTRATION NCT05694637 Registered on 7 December 2022 on clinicaltrials.gov, https://clinicaltrials.gov/search?locStr=Botswana&country=Botswana&cond=Smoking%20Cessation&intr=SBIRT.
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Affiliation(s)
- Florence Bada
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Megan E Mansfield
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lillian Okui
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Milton Montebatsi
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Carlo DiClemente
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Roy Tapera
- School of Public Health, University of Botswana, Gaborone, Botswana
- Anti-Tobacco Network, University of Botswana, Gaborone, Botswana
| | - Kaizer Ikgopoleng
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Selebaleng Mokonopi
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Jessica F Magidson
- Department of Psychology and the Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland, College Park, Maryland, USA
| | - Eberechukwu Onukwugha
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Ndwapi Ndwapi
- Botswana University of Maryland Medicine Health Initiative, Gaborone, Botswana
| | - Seth Himelhoch
- Department of Psychiatry, University of Kentucky School of Medicine, Lexington, KY, USA
| | - Bontle Mbongwe
- School of Public Health, University of Botswana, Gaborone, Botswana
- Anti-Tobacco Network, University of Botswana, Gaborone, Botswana
| | - Man Charurat
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Kaasgaard DM, Sørensen MK, Christiansen RB, Breum UN, Asiamah N, Friis LBT, Hjorth P. Video consultation and treatment in the community smoking cessation therapy success rates in patients with mental illness: a randomized controlled trial. Nord J Psychiatry 2024; 78:272-280. [PMID: 38385357 DOI: 10.1080/08039488.2024.2318305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Smoking is the single factor with the highest impact on reducing life expectancy of patients with mental illness. Patients experience difficulty in participating in smoking cessation programs but are concerned about the impact of tobacco on their health and finances. Smoking cessation advice via videoconferencing might be an alternative to an ordinary in-person consultation. MATERIAL AND METHOD Randomized controlled trial with follow-up at 6 months. We included patients with diagnoses of schizophrenia and affective disorder from psychiatric outpatient clinics. Intervention 1 involved daily video consultations; intervention 2 was treatment as usual. RESULTS Seventy patients were included. For both/all groups/interventions, rates of smoking cessation were 45% and predictors for a 50% reduction in smoking were antipsychotic medication load [odds ratio (OR) 0.54; p = 0.045] and number of nicotine patches (OR 1.02; p = 0.06). Predictors for a reduction in the number of cigarettes to < 10 were antipsychotic medication load (OR 0.52; p = 0.04), number of nicotine patches (OR 1.01; p = 0.02) and number of cigarettes at baseline [OR 0.95 (p = 0.09); adjusted OR 0.94 (p = 0.02)]. Patients prevented weight gain during the cessation period. CONCLUSION The smoking cessation rate was high. One of the reasons for the high cessation rate was that the intervention was carried out by highly experienced and professionally qualified staff. In addition, we used free nicotine patches to increase the patients' motivation to quit smoking. It is very important that we introduce these results into our clinical work with the patients.
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Affiliation(s)
- Didde Marie Kaasgaard
- Psychiatric Department, Mental Health Services, Region of Southern Denmark, University Hospital of Southern Denmark, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mette Knudsgaard Sørensen
- Psychiatric Department, Mental Health Services, Region of Southern Denmark, University Hospital of Southern, Odense, Denmark
| | | | | | - Nestor Asiamah
- Division of Interdisciplinary Research and Practice, School of Health and Social Care, University of Essex, Colchester, UK
- Department of Health Promotion, Africa Centre for Epidemiology, Accra, Accra North, Ghana
| | - Lone Bülow Toft Friis
- Psychiatric Department, Mental Health Services, Region of Southern Denmark, University Hospital of Southern, Odense, Denmark
| | - Peter Hjorth
- Psychiatric Department, Mental Health Services, Region of Southern Denmark, University Hospital of Southern Denmark, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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de la Rosa-Carrillo D, de Granda-Orive JI, Diab Cáceres L, Gutiérrez Pereyra F, Raboso Moreno B, Martínez-García MÁ, Suárez-Cuartin G. The impact of smoking on bronchiectasis and its comorbidities. Expert Rev Respir Med 2024; 18:255-268. [PMID: 38888096 DOI: 10.1080/17476348.2024.2369716] [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: 03/18/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Bronchiectasis, characterized by irreversible bronchial dilatation, is a growing global health concern with significant morbidity. This review delves into the intricate relationship between smoking and bronchiectasis, examining its epidemiology, pathophysiology, clinical manifestations, and therapeutic approaches. Our comprehensive literature search on PubMed utilized MESH terms including 'smoking,' 'smoking cessation,' 'bronchiectasis,' and 'comorbidities' to gather relevant studies. AREAS COVERED This review emphasizes the role of smoking in bronchiectasis development and exacerbation by compromising airways and immune function. Interconnected comorbidities, including chronic obstructive pulmonary disease, asthma, and gastroesophageal reflux disease, create a detrimental cycle affecting patient outcomes. Despite limited studies on smoking cessation in bronchiectasis, the review stresses its importance. Advocating for tailored cessation programs, interventions like drainage, bronchodilators, and targeted antibiotics are crucial to disrupting the inflammatory-infection-widening cycle. EXPERT OPINION The importance of smoking cessation in bronchiectasis management is paramount due to its extensive negative impact on related conditions. Proactive cessation programs utilizing technology and targeted education for high-risk groups aim to reduce smoking's impact on disease progression and related comorbidities. In conclusion, a personalized approach centered on smoking cessation is deemed vital for bronchiectasis, aiming to improve outcomes and enhance patients' quality of life in the face of this complex respiratory condition.
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Affiliation(s)
| | - José Ignacio de Granda-Orive
- Respiratory Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- School of Medicine, Complutense University, Madrid, Spain
| | - Layla Diab Cáceres
- Respiratory Department, Hospital Universitario 12 de Octubre, Madrid, Spain
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25
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Foo CYS, Potter K, Nielsen L, Rohila A, Maravic MC, Schnitzer K, Pachas GN, Levy DE, Reyering S, Thorndike AN, Cather C, Evins AE. Implementation of Community Health Worker Support for Tobacco Cessation: A Mixed-Methods Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.26.24301835. [PMID: 38343842 PMCID: PMC10854356 DOI: 10.1101/2024.01.26.24301835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Objective Adults with serious mental illness have high tobacco use disorder rates and underutilization of first-line tobacco cessation pharmacotherapy. In a randomized trial, participants offered community health worker (CHW) support and primary care provider (PCP) education had higher tobacco abstinence rates at two years, partly through increased tobacco cessation pharmacotherapy initiation. This study determined the association between participant-CHW engagement and tobacco abstinence outcomes. Methods This was a secondary, mixed-methods analysis of 196 participants in the trial's intervention arm. Effects of CHW visit number and duration, CHW co-led smoking cessation group sessions attended, and CHW-attended PCP visit number on tobacco use disorder pharmacotherapy initiation and tobacco abstinence were modeled using logistic regression. Interviews with 12 CHWs, 16 participants, and 17 PCPs were analyzed thematically. Results Year-two tobacco abstinence was associated with CHW visit number (OR=1.85, 95% CI=[1.29, 2.66]) and duration (OR=1.85, 95% CI=[1.33, 2.58]) and number of groups attended (OR=1.51, 95% CI=[1.00, 2.28]); effects on pharmacotherapy initiation were similar. 1-3 CHW visits per month over two years was optimal for achieving abstinence. Interviews identified engagement facilitators, including CHWs establishing trust, providing goal accountability, skills reinforcement, and assistance overcoming barriers to treatment access and adherence related to social determinants of health and illness factors. Robust training and supervision facilitated CHW effectiveness. Barriers included PCPs' and care teams' limited understanding of the CHW role. Conclusions Feasible CHW engagement was associated with tobacco abstinence in adults with serious mental illness. CHW implementation may benefit from promoting CHW training and integration within clinical teams.
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Affiliation(s)
- Cheryl Y. S. Foo
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Kevin Potter
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Lindsay Nielsen
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Aarushi Rohila
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | | | - Gladys N. Pachas
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Douglas E. Levy
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
- Mongan Institute, Massachusetts General Hospital, Boston, MA
| | | | - Anne N. Thorndike
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
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Gaya PV, Santos JR, Tomaz PRX, Abe TMO, Nassif M, Galas LG, Bellini BB, Moraes IR, Santos PCL, Correa PCRP, Scholz JR. Efficacy of bupropion and varenicline genetic markers in choosing pharmacological treatment for smoking cessation, and implications for combining drugs: A randomized controlled trial - GENTSMOKING. Tob Induc Dis 2024; 22:TID-22-62. [PMID: 38628555 PMCID: PMC11019925 DOI: 10.18332/tid/186072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/09/2024] [Accepted: 03/14/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Smoking cessation is the best strategy for reducing tobacco-related morbimortality. The goal of this randomized controlled trial was to test whether using the genetically favorable markers to choose a smoking cessation drug treatment (precision medicine) was superior to using the most effective drug (varenicline) in terms of abstinence rates. Additionally, combination therapy was tested when monotherapy failed. METHODS This partially blind, single-center study randomized (1:1) 361 participants into two major groups. In the genetic group (n=184), CYP2B6 rs2279343 (genotype AA) participants started treatment with bupropion, and CHRNA4 rs1044396 (genotype CT or TT) participants started treatment with varenicline; when genetic favorable to both, participants started treatment with bupropion, and when favorable to neither, on both drugs. In the control group (n=177), participants started treatment with varenicline, regardless of genetic markers. Drug treatment lasted 12 weeks. Efficacy endpoints were abstinence rates at Weeks 4, and Weeks 8-12, biochemically validated by carbon monoxide in exhaled air. Participants who did not achieve complete abstinence at Week 4, regardless of group, were given the choice to receive combination therapy. RESULTS Abstinence rates were 42.9% (95% CI: 36-64) in the control group versus 30.4% (95% CI: 23-37) in the genetic group at Week 4 (p=0.01); and 74% (95% CI: 67-80) versus 52% (95% CI: 49-64) at Week 12 (p<0.001), respectively. The strategy of combining drugs after Week 4 increased abstinence rates in both groups and the significant difference between genetic and control groups was maintained. CONCLUSIONS Results show that using these selected genetic markers was inferior to starting treatment with varenicline (control group), which is currently the most effective smoking cessation drug; moreover, the addition of bupropion in cases of varenicline monotherapy failure improves the efficacy rate until the end of treatment. CLINICAL TRIAL IDENTIFIER NCT03362099.
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Affiliation(s)
- Patricia V. Gaya
- Programa de Tratamento do Tabagismo do Servico de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Juliana R. Santos
- Laboratorio de Genetica e Biologia Molecular, Instituto do Coracao, Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo R. X. Tomaz
- Laboratorio de Genetica e Biologia Molecular, Instituto do Coracao, Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Tania M. O. Abe
- Programa de Tratamento do Tabagismo do Servico de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Miguel Nassif
- Programa de Tratamento do Tabagismo do Servico de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Larissa G. Galas
- Programa de Tratamento do Tabagismo do Servico de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bianca B. Bellini
- Programa de Tratamento do Tabagismo do Servico de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Iana R. Moraes
- Programa de Tratamento do Tabagismo do Servico de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo C. Lima Santos
- Departamento de Farmacologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Jaqueline R. Scholz
- Programa de Tratamento do Tabagismo do Servico de Prevencao e Reabilitacao, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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27
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Raspe M, Lo K, Sommer N, Andreas S. [Tobacco cessation: one of the most effective medical measures]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:365-375. [PMID: 38446181 DOI: 10.1007/s00108-024-01683-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/07/2024]
Abstract
Tobacco smoking is widespread in Germany. An increase in the number of teenagers and young adults that smoke has recently been a cause for concern. The high prevalence in Germany is contrasted by inadequate preventive measures compared to international standards. Smoking behavior should always be inquired about and documented in the same way as vital signs. All smokers, regardless of the reason for contact and motivation, should receive short, low-threshold advice, e.g. using the ABC approach (ask, brief advice, cessation). In addition to repeated advice and referral to further services, the use of nicotine replacement or drug therapy is essential for the success of quitting. The combination of long- and short-acting nicotine replacement products doubles the success rate. Electronic nicotine delivery systems are not recommended for smoking cessation.
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Affiliation(s)
- Matthias Raspe
- Fächerverbund für Infektiologie, Pneumologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Kevin Lo
- Department für Pneumologie, Medizinische Klinik II, Excellence Cluster Cardio Pulmonary Institute (CPI), Universitätsklinikum Gießen und Marburg (UKGM), Justus-Liebig-Universität Gießen, Aulweg 130, 35392, Gießen, Deutschland
- Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Gießen, Deutschland
| | - Natascha Sommer
- Department für Pneumologie, Medizinische Klinik II, Excellence Cluster Cardio Pulmonary Institute (CPI), Universitätsklinikum Gießen und Marburg (UKGM), Justus-Liebig-Universität Gießen, Aulweg 130, 35392, Gießen, Deutschland
- Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Gießen, Deutschland
| | - Stefan Andreas
- Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Gießen, Deutschland
- Lungenfachklinik Immenhausen, Robert-Koch-Straße 3, 34376, Immenhausen, Deutschland
- Abteilung Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
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Vanderkam P, Pomes C, Dzeraviashka P, Castera P, Jaafari N, Lafay-Chebassier C. Insomnia and parasomnia induced by validated smoking cessation pharmacotherapies and electronic cigarettes: a network meta-analysis. CNS Spectr 2024; 29:96-108. [PMID: 38433577 DOI: 10.1017/s1092852924000087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
We aim to assess the relationship between validated smoking cessation pharmacotherapies and electronic cigarettes (e-cigarettes) and insomnia and parasomnia using a systematic review and a network meta-analysis. A systematic search was performed until August 2022 in the following databases: PUBMED, COCHRANE, CLINICALTRIAL. Randomized controlled studies against placebo or validated therapeutic smoking cessation methods and e-cigarettes in adult smokers without unstable or psychiatric comorbidity were included. The primary outcome was the presence of "insomnia" and "parasomnia." A total of 1261 studies were selected. Thirty-seven studies were included in the quantitative analysis (34 for insomnia and 23 for parasomnia). The reported interventions were varenicline (23 studies), nicotine replacement therapy (NRT, 10 studies), bupropion (15 studies). No studies on e-cigarettes were included. Bayesian analyses found that insomnia and parasomnia are more frequent with smoking cessation therapies than placebo except for bupropion. Insomnia was less frequent with nicotine substitutes but more frequent with bupropion than the over pharmacotherapies. Parasomnia are less frequent with bupropion but more frequent with varenicline than the over pharmacotherapies. Validated smoking cessation pharmacotherapies can induce sleep disturbances with different degrees of frequency. Our network meta-analysis shows a more favorable profile of nicotine substitutes for insomnia and bupropion for parasomnia. It seems essential to systematize the assessment of sleep disturbances in the initiation of smoking cessation treatment. This could help professionals to personalize the choice of treatment according to sleep parameters of each patient. Considering co-addictions, broadening the populations studied and standardizing the measurement are additional avenues for future research.
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Affiliation(s)
- Paul Vanderkam
- Université de Poitiers, INSERM, U-1084, Laboratoire de Neurosciences Expérimentales et Cliniques, Poitiers, France
- Unité de Recherche Clinique Intersectorielle en Psychiatrie, Centre Hospitalier Henri Laborit, Poitiers, France
- Department of General Practice, University of Bordeaux, Bordeaux, France
| | - Charlotte Pomes
- Department of General Practice, University of Poitiers, Poitiers, France
| | | | - Philippe Castera
- Department of General Practice, University of Bordeaux, Bordeaux, France
| | - Nematollah Jaafari
- Unité de Recherche Clinique Intersectorielle en Psychiatrie, Centre Hospitalier Henri Laborit, Poitiers, France
| | - Claire Lafay-Chebassier
- Université de Poitiers, INSERM, U-1084, Laboratoire de Neurosciences Expérimentales et Cliniques, Poitiers, France
- CHU de Poitiers, Service de Pharmacologie Clinique et Vigilances, Poitiers, France
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Freibott CE, Biondi BE, Rao SR, Blokhina E, Dugas JN, Patts G, Bendiks S, Krupitsky E, Chichetto NE, Samet JH, Freiberg MS, Stein MD, Tindle HA. Is Abstinence from Alcohol and Smoking Associated with Less Anxiety and Depressive Symptoms Among People with HIV? AIDS Behav 2024; 28:1447-1455. [PMID: 38285292 DOI: 10.1007/s10461-023-04231-9] [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] [Accepted: 11/21/2023] [Indexed: 01/30/2024]
Abstract
Achieving abstinence from alcohol, tobacco, or both may improve mental health, but is understudied in people with HIV (PWH). The St PETER HIV randomized clinical trial compared varenicline, cytisine, and nicotine replacement therapy on alcohol and smoking behavior among 400 PWH in Russia. The primary exposure was thirty-day point prevalence abstinence (PPA) from (1) alcohol, (2) smoking, (3) both, or (4) neither and was assessed at 1, 3, 6 and 12-months as were the study outcomes of anxiety (GAD-7) and depressive (CES-D) symptoms. The primary aim was to examine the association between smoking and/or alcohol abstinence and subsequent symptoms of depression and anxiety. Primary analysis used repeated measures generalized linear modeling to relate PPA with mental health scores across time. In secondary analyses, Kruskal-Wallis tests related PPA with mental health scores at each timepoint. Primary analyses did not identify significant differences in anxiety or depressive symptoms between exposure groups over time. Secondary analyses found CES-D scores across PPA categories were similar at 1-month (11, 10, 11, 11) and 6-months (10, 10, 11, 11) but differed at 3-months (9, 11, 10, 12; p = 0.035) and 12-months (10, 6, 11, 10; p = 0.019). GAD-7 scores did not vary across PPA categories at any time point. While abstinence was associated with fewer depressive symptoms at times, findings were not consistent during follow-up, perhaps reflecting intermittent relapse. PWH with polysubstance use and mental health comorbidity are complex, and larger samples with sustained abstinence would further elucidate effects of abstinence on mental health.
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Affiliation(s)
- Christina E Freibott
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, Boston, MA, 02118, USA.
| | - Breanne E Biondi
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, Boston, MA, 02118, USA
| | - Sowmya R Rao
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Elena Blokhina
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
| | - Julianne N Dugas
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Gregory Patts
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA
| | - Sally Bendiks
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston Medical Center, Boston, MA, USA
| | - Evgeny Krupitsky
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
- Department of Addictions, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russian Federation
| | - Natalie E Chichetto
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, 32611, USA
| | - Jeffrey H Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Matthew S Freiberg
- Vanderbilt Center for Clinical Cardiovascular Trials Evaluation (V-C3REATE), Cardiovascular Division, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, Boston, MA, 02118, USA
| | - Hilary A Tindle
- Vanderbilt Center for Tobacco, Addiction and Lifestyle (VITAL), Division of Internal Medicine & Public Health and Vanderbilt Ingram Cancer Center (VICC), Vanderbilt University Medical Center, Nashville, TN, USA
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Panagopoulos VN, Bailey A, Kostopoulos GK, Ioannides AA. Changes in distinct brain systems identified with fMRI during smoking cessation treatment with varenicline: a review. Psychopharmacology (Berl) 2024; 241:653-685. [PMID: 38430396 DOI: 10.1007/s00213-024-06556-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 02/15/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Varenicline is considered one of the most effective treatment options for smoking cessation. Nonetheless, it is only modestly effective. A deeper comprehension of the effects of varenicline by means of the in-depth review of relevant fMRI studies may assist in paving the development of more targeted and effective treatments. METHODOLOGY A search of PubMed and Google Scholar databases was conducted with the keywords "functional magnetic resonance imaging" or "fMRI", and "varenicline". All peer-reviewed articles regarding the assessment of smokers with fMRI while undergoing treatment with varenicline and meeting the predefined criteria were included. RESULTS Several studies utilizing different methodologies and targeting different aspects of brain function were identified. During nicotine withdrawal, decreased mesocorticolimbic activity and increased amygdala activity, as well as elevated amygdala-insula and insula-default-mode-network functional connectivity are alleviated by varenicline under specific testing conditions. However, other nicotine withdrawal-induced changes, including the decreased reward responsivity of the ventral striatum, the bilateral dorsal striatum and the anterior cingulate cortex are not influenced by varenicline suggesting a task-dependent divergence in neurocircuitry activation. Under satiety, varenicline treatment is associated with diminished cue-induced activation of the ventral striatum and medial orbitofrontal cortex concomitant with reduced cravings; during the resting state, varenicline induces activation of the lateral orbitofrontal cortex and suppression of the right amygdala. CONCLUSIONS The current review provides important clues with regard to the neurobiological mechanism of action of varenicline and highlights promising research opportunities regarding the development of more selective and effective treatments and predictive biomarkers for treatment efficacy.
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Affiliation(s)
- Vassilis N Panagopoulos
- Laboratory for Human Brain Dynamics, AAI Scientific Cultural Services Ltd., Nicosia, Cyprus.
- Department of Physiology, Medical School, University of Patras, Patras, Greece.
| | - Alexis Bailey
- Pharmacology Section, St. George's University of London, London, UK
| | | | - Andreas A Ioannides
- Laboratory for Human Brain Dynamics, AAI Scientific Cultural Services Ltd., Nicosia, Cyprus
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Abufarsakh B, Otachi JK, Wang T, Al-Mrayat Y, Okoli CTC. The Impact of a Nurse-Led Service on Tobacco Treatment Provision Within a Psychiatric Hospital: A Time Series Study. J Am Psychiatr Nurses Assoc 2024; 30:434-440. [PMID: 35549464 DOI: 10.1177/10783903221093582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Psychiatric hospitalization is an opportunity to provide evidence-based tobacco treatment to optimize cessation efforts among people living with mental illnesses (MI). The purpose of this study was to examine the effectiveness of nurse-driven initiatives to enhance tobacco treatment within an inpatient psychiatric setting. AIMS We assessed the 4-year impact of implementing a nurse-led tobacco treatment service offered to 11,314 inpatients at admissions in a tobacco-free psychiatric facility in Kentucky. METHOD Through a time-series design, we compared the differences in rates of screening for tobacco use and providing treatment from September to December 2015 (prior to implementing the nurse-led tobacco treatment services) to each subsequent year in a 4-year period (2016-2019). RESULTS Approximately 60.0% of inpatients were persons using tobacco during the assessment period. Although there were no changes in tobacco use prevalence over the 4-year evaluation duration, there were significant increases in the provision of practical counseling and Food and Drug Administration-approved nicotine replacement therapies for persons using tobacco. CONCLUSIONS Our findings support the effectiveness of implementing tobacco treatment programs at the organizational level. Psychiatric hospitalizations provide an opportunity to optimize nurse-driven efforts to deliver tobacco treatment to people with MI. Similar models of nurse-led tobacco treatment services can be adopted within inpatient and other mental and behavioral health settings.
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Affiliation(s)
- Bassema Abufarsakh
- Bassema Abufarsakh, PhD candidate, MSN, BSN, University of Kentucky College of Nursing, Lexington, KY, USA
| | - Janet K Otachi
- Janet K. Otachi, PhD, MSW, MA, University of Kentucky College of Social Work, Lexington, KY, USA
| | - Tianyi Wang
- Tianyi Wang, MS, BS, University of Kentucky College of Arts and Sciences, Lexington, KY, USA
| | - Yazan Al-Mrayat
- Yazan Al-Mrayat, PhD, MSN, RN, University of Kentucky College of Nursing, Lexington, KY, USA
| | - Chizimuzo T C Okoli
- Chizimuzo T. C. Okoli, PhD, MPH, MSN, PMHNP-BC, APRN, FAAN, Professor, University of Kentucky College of Nursing, Lexington, KY, USA
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Agrawal S, Evison M, Ananth S, Fullerton D, McDill H, Perry M, Pollington J, Restrick L, Spencer E, Vaghela A. Medical management of inpatients with tobacco dependency. Thorax 2024; 79:3-11. [PMID: 38531603 DOI: 10.1136/thorax-2023-220607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Affiliation(s)
- Sanjay Agrawal
- Department of Respiratory Medicine, Glenfield Hospital, Institute for Lung Health, Leicester, UK
| | - Matthew Evison
- Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre (MAHSC), Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Duncan Fullerton
- Mid Cheshire Hospitals NHS Foundation Trust, Crewe, Cheshire, UK
| | | | | | | | - Louise Restrick
- Department of Respiratory Medicine, Whittington Health, London, UK
| | - Elspeth Spencer
- University Hospitals Derby & Burton NHS Foundation Trust, Burton Upon Trent, UK
| | - Ameet Vaghela
- Adur Health Partnership, Shoreham and Southwick Primary Care Network, Shoreham, UK
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Saccaro LF, Aimo A, Panichella G, Sentissi O. Shared and unique characteristics of metabolic syndrome in psychotic disorders: a review. Front Psychiatry 2024; 15:1343427. [PMID: 38501085 PMCID: PMC10944869 DOI: 10.3389/fpsyt.2024.1343427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/15/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction People with psychosis spectrum disorders (PSD) face an elevated risk of metabolic syndrome (MetS), which may reduce their life expectancy by nearly 20%. Pinpointing the shared and specific characteristics and clinical implications of MetS in PSD is crucial for designing interventions to reduce this risk, but an up-to-date review on MetS across the psychosis spectrum is lacking. Methods This narrative review fills this gap by examining the clinical literature on characteristics and implications of MetS in both distinct PSD and transdiagnostically, i.e., across traditional categorical diagnoses, with a focus on psychiatric and cardio-metabolic management. Results We discuss common and specific characteristics of MetS in PSD, as well as factors contributing to MetS development in PSD patients, including unhealthy lifestyle factors, genetic predisposition, pro-inflammatory state, drugs consumption, antipsychotic medication, and psychotic symptoms. We highlight the importance of early identification and management of cardio-metabolic risk in PSD patients, as well as the existing gaps in the literature, for instance in the screening for MetS in younger PSD patients. We compare hypotheses-generating clinical associations and characteristics of MetS in different PSD, concluding by reviewing the existing recommendations and challenges in screening, monitoring, and managing MetS in PSD. Conclusion Early identification and management of MetS are crucial to mitigate the long-term cardio-metabolic toll in PSD patients. Interventions should focus on healthy lifestyle and appropriate pharmacological and behavioral interventions. Further translational and clinical research is needed to develop targeted interventions and personalized treatment approaches for this vulnerable population, aiming at improving physical health and overall well-being.
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Affiliation(s)
- Luigi F Saccaro
- Psychiatry Department, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Psychiatry Department, Geneva University Hospital, Geneva, Switzerland
| | - Alberto Aimo
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Giorgia Panichella
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Othman Sentissi
- Psychiatry Department, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Psychiatry Department, Geneva University Hospital, Geneva, Switzerland
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Baker AL, McCarter K, Turner A, Segan C, Castle D, Brophy L, Borland R, Kelly PJ, Bonevski B, Baird D, Filia S, Attia J, Szwec S, Palazzi K, White SL, Williams JM, Wrobel AL, Ireland A, Saxby K, Ghijben P, Petrie D, Sweeney R. 'Quitlink': Outcomes of a randomised controlled trial of peer researcher facilitated referral to a tailored quitline tobacco treatment for people receiving mental health services. Aust N Z J Psychiatry 2024; 58:260-276. [PMID: 37353970 PMCID: PMC10903138 DOI: 10.1177/00048674231181039] [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] [Indexed: 06/25/2023]
Abstract
OBJECTIVE The aim of this study was to test the effectiveness of a tailored quitline tobacco treatment ('Quitlink') among people receiving support for mental health conditions. METHODS We employed a prospective, cluster-randomised, open, blinded endpoint design to compare a control condition to our 'Quitlink' intervention. Both conditions received a brief intervention delivered by a peer researcher. Control participants received no further intervention. Quitlink participants were referred to a tailored 8-week quitline intervention delivered by dedicated Quitline counsellors plus combination nicotine replacement therapy. The primary outcome was self-reported 6 months continuous abstinence from end of treatment (8 months from baseline). Secondary outcomes included additional smoking outcomes, mental health symptoms, substance use and quality of life. A within-trial economic evaluation was conducted. RESULTS In total, 110 participants were recruited over 26 months and 91 had confirmed outcomes at 8 months post baseline. There was a difference in self-reported prolonged abstinence at 8-month follow-up between Quitlink (16%, n = 6) and control (2%, n = 1) conditions, which was not statistically significant (OR = 8.33 [0.52, 132.09] p = 0.131 available case). There was a significant difference in favour of the Quitlink condition on 7-day point prevalence at 2 months (OR = 8.06 [1.27, 51.00] p = 0.027 available case). Quitlink costs AU$9231 per additional quit achieved. CONCLUSION The Quitlink intervention did not result in significantly higher rates of prolonged abstinence at 8 months post baseline. However, engagement rates and satisfaction with the 'Quitlink' intervention were high. While underpowered, the Quitlink intervention shows promise. A powered trial to determine its effectiveness for improving long-term cessation is warranted.
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Affiliation(s)
- Amanda L Baker
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
| | - Kristen McCarter
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, NSW, Australia
| | - Alyna Turner
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Catherine Segan
- Cancer Council Victoria, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - David Castle
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, ON, Canada
| | - Lisa Brophy
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Social Work and Social Policy, School of Allied Health, Human Services and Sport, La Trobe University Melbourne, VIC, Australia
| | - Ron Borland
- Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Peter J Kelly
- Illawarra Health and Medical Research Institute and the School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute (FHMRI), College of Medicine & Public Health, Flinders University, Bedford Park, SA, Australia
| | - Donita Baird
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
| | - Sacha Filia
- Cancer Council Victoria, Melbourne, VIC, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
| | - Stuart Szwec
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | | | - Jill M Williams
- Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Anna L Wrobel
- IMPACT – The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Andrew Ireland
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Karinna Saxby
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Peter Ghijben
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Rohan Sweeney
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
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Lin HX, Liu Z, Hajek P, Zhang WT, Wu Y, Zhu BC, Liu HH, Xiang Q, Zhang Y, Li SB, Pesola F, Wang YY. Efficacy of Electronic Cigarettes vs Varenicline and Nicotine Chewing Gum as an Aid to Stop Smoking: A Randomized Clinical Trial. JAMA Intern Med 2024; 184:291-299. [PMID: 38285562 PMCID: PMC10825782 DOI: 10.1001/jamainternmed.2023.7846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/30/2023] [Indexed: 01/31/2024]
Abstract
Importance Electronic cigarettes (ECs) are often used by smokers as an aid to stopping smoking, but evidence is limited regarding their efficacy compared with nicotine replacement therapy (NRT), and no evidence is available on how their efficacy compares with that of varenicline. Objective To evaluate whether ECs are superior to NRT and noninferior to varenicline in helping smokers quit. Design, Setting, and Participants This was a randomized clinical trial conducted at 7 sites in China and including participants who were smoking at least 10 cigarettes per day and motivated to quit, not using stop-smoking medications or EC, and willing to use any of the study products. Participants were first recruited in May 2021, and data analysis was conducted in December 2022. Interventions A cartridge-based EC (30 mg/mL nicotine salt for 2 weeks and 50 mg/mL after that), varenicline (0.5 mg, once a day for 3 days; 0.5 mg, twice a day for 4 days; and 1 mg, twice a day, after that), and 2 mg (for smokers of ≤20 cigarettes per day) or 4 mg (>20 cigarettes per day) nicotine chewing gum, all provided for 12 weeks and accompanied by minimal behavioral support (an invitation to join a self-help internet forum). Main Outcomes and Measures The primary outcome was sustained abstinence from smoking at 6 months as validated by an expired-air carbon monoxide reading (<8 parts per million). Participants lost to follow-up were included as nonabstainers. Results Of 1068 participants, 357 (33.5%) were female, and the mean (SD) age was 33.9 (3.1) years. A total of 409 (38.3%), 409 (38.3%), and 250 (23.4%) participants were randomized to the EC, varenicline, and NRT arms, respectively. The 6-month biochemically validated abstinence rates were 15.7% (n = 64), 14.2% (n = 58), and 8.8% (n = 22) in the EC, varenicline, and NRT study arms, respectively. The quit rate in the EC arm was noninferior to the varenicline arm (absolute risk reduction, 1.47%; 95% CI, -1.41% to 4.34%) and higher than in the NRT arm (odds ratio, 1.92; 95% CI, 1.15-3.21). Treatment adherence was similar in all study arms during the initial 3 months, but 257 participants (62.8%) in the EC arm were still using ECs at 6 months, with no further use in the 2 other study arms. The most common adverse reactions were throat irritation (32 [7.8%]) and mouth irritation (28 [6.9%]) in the EC arm, nausea (36 [8.8%]) in the varenicline arm, and throat irritation (20 [8.0%]) and mouth irritation (22 [8.8%]) in the NRT arm. No serious adverse events were recorded. Conclusions and Relevance The results of this randomized clinical trial found that when all treatments were provided with minimal behavior support, the efficacy of EC was noninferior to varenicline and superior to nicotine chewing gum. Trial Registration Chinese Clinical Trial Registry: ChiCTR2100048156.
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Affiliation(s)
- Hao-Xiang Lin
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Zhao Liu
- Department of Tobacco Control and Prevention of Respiratory Disease, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Peter Hajek
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Wan-Tong Zhang
- Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuan Wu
- China Academy of Chinese Medical Sciences, Beijing, China
| | - Bao-Chen Zhu
- Department of Pharmacy, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hai-Hua Liu
- Department of Traditional Chinese Medicine, Beijing Geriatric Hospital, Beijing, China
| | - Qiu Xiang
- Respiratory Intensive Care Unit, Tongji Hospital Affiliated with Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yan Zhang
- Office of China Journal of Traditional Chinese Medicine and Pharmacy, Beijing, China
| | - Shu-Bin Li
- Beijing PL Technology Co, Ltd, Beijing, China
| | - Francesca Pesola
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Ying-Ying Wang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
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Lee CM, Seo YB, Paek YJ, Lee ES, Kang HS, Kim SY, Roh S, Park DW, An YS, Jo SH. Evidence-Based Guideline for the Treatment of Smoking Cessation Provided by the National Health Insurance Service in Korea. Korean J Fam Med 2024; 45:69-81. [PMID: 38414371 DOI: 10.4082/kjfm.23.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/03/2023] [Indexed: 02/29/2024] Open
Abstract
Although major countries, such as South Korea, have developed and disseminated national smoking cessation guidelines, these efforts have been limited to developing individual societies or specialized institution-based recommendations. Therefore, evidence-based clinical guidelines are essential for developing smoking cessation interventions and promoting effective smoking cessation treatments. This guideline targets frontline clinical practitioners involved in a smoking cessation treatment support program implemented in 2015 with the support of the National Health Insurance Service. The Guideline Development Group of 10 multidisciplinary smoking cessation experts employed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach to review recent domestic and international research and guidelines and to determine evidence levels using the GRADE methodology. The guideline panel formulated six strong recommendations and one conditional recommendation regarding pharmacotherapy choices among general and special populations (mental disorders and chronic obstructive lung disease [COPD]). Strong recommendations favor varenicline rather than a nicotine patch or bupropion, using varenicline even if they are not ready to quit, using extended pharmacotherapy (>12 weeks) rather than standard treatment (8-12 weeks), or using pharmacotherapy for individuals with mental disorders or COPD. The conditional recommendation suggests combining varenicline with a nicotine patch instead of using varenicline alone. Aligned with the Korean Society of Medicine's clinical guideline development process, this is South Korea's first domestic smoking cessation treatment guideline that follows standardized guidelines. Primarily focusing on pharmacotherapy, it can serve as a foundation for comprehensive future smoking cessation clinical guidelines, encompassing broader treatment topics beyond medications.
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Affiliation(s)
- Cheol Min Lee
- Department of Family Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo-Bin Seo
- Department of Family Medicine, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Yu-Jin Paek
- Department of Family Medicine and Health Promotion Center, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eon Sook Lee
- Department of Family Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hye Seon Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary's Hospital, Bucheon, Korea
| | - Soo Young Kim
- Department of Family Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Sungwon Roh
- Department of Psychiatry, Hanyang University Hospital, Seoul, Korea
| | - Dong Won Park
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yoo Suk An
- Department of Psychiatry, Seoul National University Hospital, Seoul, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 175] [Impact Index Per Article: 175.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Lüthi H, Lengsfeld S, Burkard T, Meienberg A, Jeanloz N, Vukajlovic T, Bologna K, Steinmetz M, Bathelt C, Sailer CO, Laager M, Vogt DR, Hemkens LG, Speich B, Urwyler SA, Kühne J, Baur F, Lutz LN, Erlanger TE, Christ-Crain M, Winzeler B. Effect of dulaglutide in promoting abstinence during smoking cessation: 12-month follow-up of a single-centre, randomised, double-blind, placebo-controlled, parallel group trial. EClinicalMedicine 2024; 68:102429. [PMID: 38371479 PMCID: PMC10873660 DOI: 10.1016/j.eclinm.2024.102429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 02/20/2024] Open
Abstract
Background Smoking cessation is challenging, despite making use of established smoking cessation therapies. Preclinical studies and one clinical pilot study suggest the antidiabetic drug glucagon-like peptide-1 (GLP-1) analogue to modulate addictive behaviours and nicotine craving. Previously, we reported the short-term results of a randomised, double-blind, placebo-controlled trial. Herein we report long-term abstinence rates and weight developments after 24 and 52 weeks. Methods This single-centre, randomised, double-blind, placebo-controlled, parallel group trial was done at the University Hospital Basel in Switzerland. We randomly assigned (1:1) individuals with at least a moderate nicotine dependence willing to quit smoking to either a 12-week treatment with dulaglutide 1.5 mg or placebo subcutaneously once weekly in addition to standard of care smoking cessation therapy (varenicline 2 mg/day and behavioural counselling). After 12 weeks, dulaglutide or placebo injections were discontinued and the participants were followed up at week 24 and 52. The primary outcome of self-reported and biochemically confirmed point prevalence abstinence rate, and secondary outcome of secondary outcome of weight change were assessed at weeks 24 and 52. All participants who received one dose of the study drug were included in the intention to treat set and participants who received at least 10/12 doses of the study drug formed the per protocol set. The trial was registered at ClinicalTrials.gov, NCT03204396. Findings Of the 255 participants who were randomly assigned between June 22, 2017 and December 3, 2020, 63% (80/127) (dulaglutide group) and 65% (83/128) (placebo group) were abstinent after 12 weeks. These abstinence rates declined to 43% (54/127) and 41% (52/128), respectively, after 24 weeks and to 32% (41/127) and 32% (41/128), respectively, after 52 weeks. Post-cessation weight gain was prevented in the dulaglutide group (-1.0 kg, standard deviation [SD] 2.7) as opposed to the placebo group (+1.9 kg, SD 2.4) after 12 weeks. However, at week 24, increases in weight from baseline were observed in both groups (median, interquartile range [IQR]: dulaglutide: +1.5 kg, [-0.4, 4.1], placebo: +3.0 kg, [0.6, 4.6], baseline-adjusted difference in weight change -1.0 kg (97.5% CI [-2.16, 0.16])), and at week 52 the groups showed similar weight gain (median, IQR: dulaglutide: +2.8 kg [-0.4, 4.7], placebo: +3.1 kg [-0.4, 6.0], baseline-adjusted difference in weight change: -0.35 kg (95% CI [-1.72, 1.01])). In the follow-up period (week 12 to week 52) 51 (51%) and 48 (48%) treatment-unrelated adverse events were recorded in the dulaglutide and the placebo group, respectively. No treatment-related serious adverse events or deaths occurred. Interpretation Dulaglutide does not improve long-term smoking abstinence, but has potential to counteract weight gain after quitting. However, 3 months of treatment did not have a sustained beneficial effect on weight at 1 year. As post-cessation weight gain is highest in the first year after quitting smoking, future studies should consider a longer treatment duration with a GLP-1 analogue in abstinent individuals. Funding Swiss National Science Foundation, the Gottfried and Julia Bangerter-Rhyner Foundation, the Goldschmidt-Jacobson Foundation, the Hemmi-Foundation, the University of Basel, the Swiss Academy of Medical Sciences.
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Affiliation(s)
- Hualin Lüthi
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sophia Lengsfeld
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thilo Burkard
- Medical Outpatient Department, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Andrea Meienberg
- Medical Outpatient Department, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Faculty of Medicine University of Basel, Basel, Switzerland
| | - Nica Jeanloz
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tanja Vukajlovic
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Katja Bologna
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michelle Steinmetz
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Cemile Bathelt
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Clara O. Sailer
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mirjam Laager
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Deborah R. Vogt
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lars G. Hemkens
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Benjamin Speich
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sandrine A. Urwyler
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jill Kühne
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Fabienne Baur
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Linda N. Lutz
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias E. Erlanger
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Bettina Winzeler
- Department of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
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Nordanstig J, Behrendt CA, Baumgartner I, Belch J, Bäck M, Fitridge R, Hinchliffe R, Lejay A, Mills JL, Rother U, Sigvant B, Spanos K, Szeberin Z, van de Water W, Antoniou GA, Björck M, Gonçalves FB, Coscas R, Dias NV, Van Herzeele I, Lepidi S, Mees BME, Resch TA, Ricco JB, Trimarchi S, Twine CP, Tulamo R, Wanhainen A, Boyle JR, Brodmann M, Dardik A, Dick F, Goëffic Y, Holden A, Kakkos SK, Kolh P, McDermott MM. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg 2024; 67:9-96. [PMID: 37949800 DOI: 10.1016/j.ejvs.2023.08.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 11/12/2023]
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Olsson Y, Lidö H, Ademar K, Cadeddu D, Ericson M, Söderpalm B. The GlyT1-inhibitor Org 24598 facilitates the alcohol deprivation abolishing and dopamine elevating effects of bupropion + varenicline in rats. J Neural Transm (Vienna) 2024; 131:95-106. [PMID: 37773223 PMCID: PMC10769923 DOI: 10.1007/s00702-023-02701-x] [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: 04/04/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
Alcohol Use Disorder (AUD) is a relapsing brain disorder that involves perturbations of brain dopamine (DA) systems, and combined treatment with varenicline + bupropion produces additive effects on accumbal DA output and abolishes the alcohol deprivation effect (ADE) in rats. Also, direct and indirect glycine receptor (GlyR) agonists raise basal DA, attenuate alcohol-induced DA release in the nucleus Accumbens (nAc) and reduce alcohol consumption in rats. This study in rats examines whether the GlyT1-inhibitor Org 24598, an indirect GlyR agonist, enhances the ADE-reducing and DA elevating action of the combined administration of varenicline + bupropion in lower doses than previously applied. Effects on voluntary alcohol consumption, the ADE and extracellular levels of glycine and DA in nAc were examined following treatment with Org 24598 6 and 9 mg/kg i.p., bupropion 3.75 mg/kg i.p. and varenicline 1.5 mg/kg s.c., in monotherapy or combined, using a two-bottle, free-choice alcohol consumption paradigm with an ADE paradigm, and in vivo microdialysis in male Wistar rats. Notably, all treatment regimens appeared to abolish the ADE but only the effect produced by the triple combination (Org24598 + varenicline + bupropion) was significant compared to vehicle. Hence, addition of Org 24598 may enhance the ADE-reducing action of varenicline + bupropion and appears to allow for a dose reduction of bupropion. Treatment with Org 24598 raised accumbal glycine levels but did not significantly alter DA output in monotherapy. Varenicline + bupropion produced a substantial elevation in accumbal DA output that was slightly enhanced following addition of Org 24598. Conceivably, the blockade of the ADE is achieved by the triple combination enhancing accumbal DA transmission in complementary ways, thereby alleviating a hypothesized hypodopaminergia and negative reinforcement to drink. Ultimately, combining an indirect or direct GlyR agonist with varenicline + bupropion may constitute a new pharmacological treatment principle for AUD, although further refinement in dosing and evaluation of other glycinergic compounds are warranted.
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Affiliation(s)
- Yasmin Olsson
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, PO Box 410, 405 30, Gothenburg, SE, Sweden.
- Beroendekliniken, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Helga Lidö
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, PO Box 410, 405 30, Gothenburg, SE, Sweden
- Beroendekliniken, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Ademar
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, PO Box 410, 405 30, Gothenburg, SE, Sweden
| | - Davide Cadeddu
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, PO Box 410, 405 30, Gothenburg, SE, Sweden
| | - Mia Ericson
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, PO Box 410, 405 30, Gothenburg, SE, Sweden
| | - Bo Söderpalm
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, PO Box 410, 405 30, Gothenburg, SE, Sweden
- Beroendekliniken, Sahlgrenska University Hospital, Gothenburg, Sweden
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Lua YHA, How CH, Ng CWM. Smoking cessation in primary care. Singapore Med J 2024; 65:38-44. [PMID: 38212983 PMCID: PMC10863739 DOI: 10.4103/singaporemedj.smj-2022-034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/13/2022] [Indexed: 01/13/2024]
Affiliation(s)
| | - Choon How How
- Care and Health Integration, Changi General Hospital, Singapore
- Family Medicine Academic Clinical Programme, SingHealth Duke-NUS, Singapore
| | - Chung Wai Mark Ng
- Family Medicine Academic Clinical Programme, SingHealth Duke-NUS, Singapore
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Rojewski AM, Palmer AM, Baker NL, Toll BA. Smoking Cessation Pharmacotherapy Efficacy in Comorbid Medical Populations: Secondary Analysis of the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) Randomized Clinical Trial. Nicotine Tob Res 2024; 26:31-38. [PMID: 37474127 PMCID: PMC10734386 DOI: 10.1093/ntr/ntad126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION This study sought to compare medication efficacy in participants with medical comorbidities who smoke in the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) trial, a double-blind, triple-dummy, placebo- and active-controlled randomized controlled trial. AIMS AND METHODS Participants were from the U.S. cohort of the main trial and randomized (1:1:1:1) to varenicline, bupropion, nicotine replacement therapy (NRT) patch, or placebo for 12 weeks with follow-up through week 24. Medical comorbidity data were derived from the baseline medical screening questionnaire and categorized into four subgroups (cardiac, respiratory, vascular, and diabetes). Within each comorbidity, generalized linear mixed models were used to assess the association between treatment and continuous abstinence rates from weeks 9-12 to 9-24. Similar models were used to test the effect of number of comorbidities on abstinence. RESULTS Varenicline resulted in the highest week 12 abstinence rates across all pharmacotherapies and compared to placebo in all comorbidity subgroups: Cardiac (40.0% vs. 3.6%; odds ratios [OR] = 23.3 [5.1-107.1]), respiratory (24.7% vs. 12.8%; OR = 2.2 [1.3-3.8]), vascular (29.1% vs. 10.4%; OR = 3.6 [2.3-5.7]), and diabetes (30.9% vs. 8.3%; OR = 6.5 [2.3-19.0]). This was maintained at week 24 for those with cardiac (23.3% vs. 1.8%; OR = 21.7 [2.7-178.2]), vascular (18.9% vs. 7.1%; OR = 3.1 [1.8-5.3]), and diabetes (20.6% vs. 4.2%; OR = 8.4 [2.1-33.7]) comorbidities. Treatment contrasts within some comorbidity subgroups revealed superior efficacy of varenicline over other pharmacotherapies. All pharmacotherapies increased the odds of abstinence regardless of number of comorbidities. CONCLUSIONS Varenicline is the most efficacious option for patients with manageable cardiac, respiratory, vascular, and diabetes conditions to quit smoking, supporting recent clinical practice guidelines that recommend varenicline as first-line pharmacotherapy. Bupropion and NRT demonstrated efficacy for some comorbidity subgroups. IMPLICATIONS This secondary analysis of the EAGLES trial demonstrated that varenicline is the most efficacious option for patients with cardiac, respiratory, vascular, and diabetes diagnoses to quit smoking. This demonstration of varenicline efficacy among individuals with comorbid medical conditions supports recent clinical practice guidelines that recommend varenicline as a first-line pharmacotherapy for smoking cessation.
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Affiliation(s)
- Alana M Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Amanda M Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA
| | - Nathaniel L Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA
| | - Benjamin A Toll
- Department of Public Health Sciences, Medical University of South Carolina, Charleston SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
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Mauries S, Bertrand L, Frija-Masson J, Benzaquen H, Kalamarides S, Sauvage K, Lejoyeux M, d’Ortho MP, Geoffroy PA. Effects of smoking on sleep architecture and ventilatory parameters including apneas: Results of the Tab-OSA study. Sleep Med X 2023; 6:100085. [PMID: 37736106 PMCID: PMC10509708 DOI: 10.1016/j.sleepx.2023.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023] Open
Abstract
Background The interaction between smoking and sleep seems appears to be bidirectional, but few studies evaluated the impact of smoking and its cessation on objective sleep parameters. In this context, this new study aimed to assess the impact of smoking and its cessation on sleep architecture and on ventilatory sleep parameters, particularly the presence of sleep apnea syndrome (apnea-hypopnea index (AHI)≥15). Methods: Patients hospitalized for polysomnographic sleep exploration were compared according to their smoking status: active smokers (AS), former smokers (FS), non-smokers (NoNi). Psychiatric and non-psychiatric co-morbidities and treatment or substance use were taken into account in the analyses. Results A total of 170 participants were included (N = 37 FS, 39 AS, 86 NoNi). A significant decrease in the mean nocturnal O2 saturation was observed for FS and AS compared to NoNi. No differences were found regarding AHI. Regarding sleep architecture, we observed a significant decrease in the slow wave sleep duration for AS compared to NoNi, and interestingly not between FS and NoNi. Conclusion This study suggests that current smokers suffer from alterations in both sleep architecture and ventilatory parameters, the later appears to persist even after smoking cessation.
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Affiliation(s)
- Sibylle Mauries
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France
| | - Léa Bertrand
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France
| | - Justine Frija-Masson
- Université de Paris, NeuroDiderot, Inserm, U1141, 48 boulevard Sérurier, 75019, Paris, France
- Explorations Fonctionnelles et Centre du Sommeil- Département de Physiologie Clinique, Assistance Publique des Hôpitaux de Paris, GHU Paris Nord, DMU DREAM, Hôpital Bichat, 46 rue Henri Huchard, 75018, Paris, France
| | - Hélène Benzaquen
- Explorations Fonctionnelles et Centre du Sommeil- Département de Physiologie Clinique, Assistance Publique des Hôpitaux de Paris, GHU Paris Nord, DMU DREAM, Hôpital Bichat, 46 rue Henri Huchard, 75018, Paris, France
| | - Sophie Kalamarides
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Beaujon, 100 boulevard Général Leclerc, 92110, Clichy, France
| | - Karine Sauvage
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France
| | - Michel Lejoyeux
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France
- GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014, Paris, France
| | - Marie-Pia d’Ortho
- Université de Paris, NeuroDiderot, Inserm, U1141, 48 boulevard Sérurier, 75019, Paris, France
- Explorations Fonctionnelles et Centre du Sommeil- Département de Physiologie Clinique, Assistance Publique des Hôpitaux de Paris, GHU Paris Nord, DMU DREAM, Hôpital Bichat, 46 rue Henri Huchard, 75018, Paris, France
| | - Pierre A. Geoffroy
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France
- GHU Paris - Psychiatry & Neurosciences, 1 rue Cabanis, 75014, Paris, France
- Université de Paris, NeuroDiderot, Inserm, U1141, 48 boulevard Sérurier, 75019, Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5 rue Blaise Pascal, 67000, Strasbourg, France
- Département de Psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Beaujon, 100 boulevard Général Leclerc, 92110, Clichy, France
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Pataka A, Kotoulas SC, Karkala A, Tzinas A, Kalamaras G, Kasnaki N, Sourla E, Stefanidou E. Obstructive Sleep Apnea and Smoking Increase the Risk of Cardiovascular Disease: Smoking Cessation Pharmacotherapy. J Clin Med 2023; 12:7570. [PMID: 38137639 PMCID: PMC10743586 DOI: 10.3390/jcm12247570] [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: 11/12/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Tobacco smoking has been a recognized risk factor for cardiovascular diseases (CVD). Smoking is a chronic relapsing disease and pharmacotherapy is a main component of smoking cessation. Obstructive sleep apnea (OSA) and smoking both increase the risk of CVD and are associated with significant morbidity and mortality. There are few existing data examining how pharmacological treatment, such as nicotine replacement therapy (NRT), bupropion, and varenicline, affect smokers suffering with OSA and especially their cardiovascular effects. The aim of this review was to evaluate the effects of smoking cessation pharmacotherapy on OSA with a special emphasis on the cardiovascular system. Results: Only small studies have assessed the effect of NRTs on OSA. Nicotine gum administration showed an improvement in respiratory events but with no permanent results. No specific studies were found on the effect of bupropion on OSA, and a limited number evaluated varenicline's effects on sleep and specifically OSA. Varenicline administration in smokers suffering from OSA reduced the obstructive respiratory events, especially during REM. Studies on second-line medication (nortriptyline, clonidine, cytisine) are even more limited. There are still no studies evaluating the cardiovascular effects of smoking cessation medications on OSA patients. Conclusions: Sleep disturbances are common withdrawal effects during smoking cessation but could be also attributed to pharmacotherapy. Smokers should receive personalized treatment during their quitting attempts according to their individual needs and problems, including OSA. Future studies are needed in order to evaluate the efficacy and safety of smoking cessation medications in OSA patients.
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Affiliation(s)
- Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | | | - Aliki Karkala
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | - Asterios Tzinas
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | - George Kalamaras
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | - Nectaria Kasnaki
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | - Evdokia Sourla
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
| | - Emiliza Stefanidou
- Respiratory Failure Unit, G. Papanikolaou Hospital Thessaloniki, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (A.K.); (A.T.); (G.K.); (N.K.); (E.S.); (E.S.)
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Green EW, Byers IS, Deutsch-Link S. Closing the Care Gap: Management of Alcohol Use Disorder in Patients with Alcohol-associated Liver Disease. Clin Ther 2023; 45:1189-1200. [PMID: 38052695 DOI: 10.1016/j.clinthera.2023.09.017] [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: 07/15/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 12/07/2023]
Abstract
Alcohol-associated liver disease (ALD)-related morbidity and mortality are rising in the United States. Although effective medications and behavioral interventions are available for the treatment of patients with alcohol use disorder (AUD), patients with ALD are profoundly undertreated for AUD. This article reviews the management of AUD in patients with ALD, with a focus on appropriate screening and diagnosis, management of alcohol withdrawal syndrome, pharmacotherapy for AUD, alcohol biomarkers, and behavioral interventions. Expanding access to AUD treatment is imperative for improving health outcomes in patients with ALD.
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Affiliation(s)
- Ellen W Green
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Isabelle S Byers
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sasha Deutsch-Link
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
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Anthenelli RM, McKenna BS, Giannini J, Attaluri SV, Rubin M, O'Crowley E, Miller S, Heffner JL. Combining varenicline preloading with Acceptance and Commitment Therapy (ACT) in persons with serious mental illness who smoke: The randomized ACTSLow pilot feasibility trial. Drug Alcohol Depend 2023; 253:111012. [PMID: 37931328 DOI: 10.1016/j.drugalcdep.2023.111012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND People with serious mental illness (SMI; bipolar [BD] or schizophrenia spectrum disorders [SSD]) who smoke have 30-60% lower odds of quitting and are more prone to experience neuropsychiatric adverse events (NPSAEs) when quitting than smokers without SMI. We pilot-tested the feasibility of combining two different dosing strategies of varenicline preloading with Acceptance and Commitment Therapy (ACT) in persons with SMI in an attempt to bolster quit rates without increasing NPSAEs. METHODS Twelve-week, single center, randomized, double-blind, pilot feasibility trial of low (0.5mg twice daily, slower titration) versus standard dose (1.0mg twice daily, standard titration) varenicline in persons with BD or SSD with a 12-week follow-up. All participants received up to 10 sessions of ACT for smoking cessation. Participants were asked to preload with varenicline while still smoking and set a flexible target quit day (TQD) by day 35. RESULTS Recruitment was hampered by shutdowns related to COVID-19 and the worldwide varenicline recall, respectively. Retention goals were met. Treatment satisfaction was high across both dosing and diagnostic groups. Most participants (92.9%) adhered to preloading instructions and the flexible TQD. Seven-day point prevalence abstinence at week 12 was highest in BD participants (37.5%) but lowest in SSD participants (16.7%) who received the standard dose. Medication was well tolerated. CONCLUSIONS Although recruitment was hindered by unanticipated world events, feasibility was demonstrated. Participants adhered to and were highly satisfied with the combination of pre-cessation varenicline plus ACT. Findings support testing this combined treatment approach in a fully powered trial of persons with BD who smoke.
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Affiliation(s)
- Robert M Anthenelli
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States.
| | - Benjamin S McKenna
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States; VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States
| | - Jillian Giannini
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States
| | - Saisantosh V Attaluri
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States
| | - Matine Rubin
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States
| | - Erin O'Crowley
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States
| | - Sierra Miller
- Pacific Treatment and Research Center, Department of Psychiatry, University of California, San Diego, 3252 Holiday Court, Suite 200, La Jolla, CA 92037, United States
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA 98109, United States
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Jackson AB, Gibbons FX, Fleischli ME, Haeny AM, Bold KW, Suttiratana SC, Fagan P, Krishnan-Sarin S, Gerrard M. Association of racial discrimination in health care settings and use of electronic cigarettes to quit smoking among Black adults. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:208985. [PMID: 36822270 PMCID: PMC10442461 DOI: 10.1016/j.josat.2023.208985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/28/2022] [Accepted: 02/12/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Black people are disproportionately burdened by tobacco-related diseases and are less successful at cigarette cessation with current treatments. We know little about the effectiveness of e-cigarettes as a smoking cessation method compared to currently approved methods in Black adults who smoke. Many Black adults report experiencing racial discrimination in health care, but if discrimination is related to utilization of smoking cessation aids including e-cigarettes and success with smoking cessation in this population is unclear. Therefore, this exploratory study aimed to understand how negative experiences and racial discrimination in health care influence use of e-cigarettes for cigarette cessation and success with cigarette cessation among Black adults. METHODS The study interviewed 201 Black adults who used cigarettes and tried to quit in their lifetime from the Family and Community Health Study in 2016. The study asked if they had tried and successfully quit cigarettes with e-cigarettes vs. other methods (support groups, medications, nicotine replacement therapies, call-in help lines, cold turkey [quit on their own], counseling) and asked about their negative experiences and racial discrimination in health care. We performed separate logistic regressions that evaluated the association of negative experiences and racial discrimination in health care with 1) use of e-cigarettes for cigarette cessation vs. other quitting methods and 2) success with cigarette cessation using any method among Black adults while controlling for age, sex, socioeconomic status, health insurance status, and age of onset of cigarette use. RESULTS More reported negative experiences and racial discrimination in health care were associated with ever trying to quit with e-cigarettes compared to other methods (OR:1.75, 95 % CI [1.05-2.91]), but negative experiences and racial discrimination in health care were not associated with cigarette quitting success. Interestingly, trying e-cigarettes was associated with being less successful at quitting compared to using other methods to quit smoking (OR: 0.40, 95 % CI [0.20, 0.81]). CONCLUSIONS These results suggest that educating health care professionals that anticipated discrimination in health care settings may be driving Black adults who smoke to engage in non-evidence-based smoking cessation practices, such as e-cigarettes instead of those that are evidence-based, and may be more effective in this population.
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Affiliation(s)
- Asti B Jackson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America.
| | - Frederick X Gibbons
- Department of Psychological Sciences, University of Connecticut, United States of America
| | - Mary E Fleischli
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, United States of America
| | - Angela M Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Krysten W Bold
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America
| | - Sakinah C Suttiratana
- Department of Chronic Disease Epidemiology, Yale School of Public Health, United States of America
| | - Pebbles Fagan
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, United States of America
| | | | - Meg Gerrard
- Department of Psychological Sciences, University of Connecticut, United States of America
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Türk A, Ünsal E, Engin E, Kayahan B. Return to Community Mental Health Centers after the Pandemic: A Qualitative Study on Turkish Patients' Subjective Experiences. Niger J Clin Pract 2023; 26:1792-1799. [PMID: 38158344 DOI: 10.4103/njcp.njcp_739_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 09/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Community mental health centers (CMHCs) are important institutions for individuals with chronic mental illness. During the COVID-19 period, patients with mental health could not optimally access care in CMHCs. AIM To explore the experiences of patients using a CMHC after its closure due to the COVID-19 pandemic. PATIENTS AND METHODS This was a descriptive qualitative study that included 16 patients with mental disorders who regularly used CMHCs during the pre-pandemic period. Their data were collected between March 2022 and August 2022 using face-to-face, in-depth semi-structured interviews. All interviews were recorded and the content analysis method was used to analyze the data. RESULTS The age range of the 16 study participants was 29-53 years with a mean age of 40.8 ± 6.5 years. Nine (56.3%) participants were men, and 7 (43.7%) were women. Ten (62.5%) participants had schizophrenia, whereas 6 (37.5%) had bipolar disorder. According to content analysis, the five main themes that emerged based on the statements of participants were the effects of change, difficulties experienced, support needs, coping experiences, and suggestions. The results showed that although patients using CMHCs are struggling with the adverse consequences of the pandemic process, they also have difficulty managing their diseases and daily life due to their inability to access psychosocial services in the CMHCs. CONCLUSION The patients reported their negative experiences and need for support during the pandemic. The study highlights the need to adequately accommodate mental health services delivery during future pandemics that may impose movement restrictions.
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Affiliation(s)
- A Türk
- Mental Health Nursing Department, Ege University Faculty of Nursing, Turkey
| | - E Ünsal
- Mental Health Nursing Department, Ege University Faculty of Nursing, Turkey
| | - E Engin
- Mental Health Nursing Department, Ege University Faculty of Nursing, Turkey
| | - B Kayahan
- Department of Mental Health and Diseases, Community Mental Health, Ege University Faculty of Medicine, Turkey
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Miley KM, Hooker SA, Crain AL, O'Connor PJ, Haapala JL, Bond DJ, Rossom RC. 30-year Cardiovascular Disease Risk for Young Adults with Serious Mental Illness. Gen Hosp Psychiatry 2023; 85:139-147. [PMID: 38487652 PMCID: PMC10936711 DOI: 10.1016/j.genhosppsych.2023.10.015] [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] [Indexed: 03/17/2024]
Abstract
Objective To estimate 30-year CVD risk and modifiable risk factors in young adults with serious mental illness (SMI) versus those without, and assess variations in CVD risk by race, ethnicity, and sex. Method In this cross-sectional study, we estimated and compared the Framingham 30-year CVD risk score and individual modifiable CVD risk factors in young adult (20-39 years) primary care patients with and without SMI at two US healthcare systems (January 2016-Septemeber 2018). Interaction terms assessed whether the SMI-risk association differed across demographic groups. Results Covariate-adjusted 30-year CVD risk was significantly higher for those with (n=4228) versus those without (n=155,363) SMI (RR 1.28, 95% CI [1.26, 1.30]). Patients with SMI had higher rates of hypertension (OR 2.02 [1.7, 2.39]), diabetes (OR 3.14 [2.59, 3.82]), obesity (OR 1.93 [1.8, 2.07]), and smoking (OR 4.94 [4.6, 5.36]). The increased 30-year CVD risk associated with SMI varied significantly by race and sex: there was an 8% higher risk in Black compared to White patients (RR 1.08, [1.04, 1.12]) and a 9% lower risk in men compared to women (RR 0.91 [0.88, 0.94]). Conclusions Young adults with SMI are at increased 30-year risk of CVD, and further disparities exist for Black individuals and women.
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Affiliation(s)
- Kathleen M Miley
- HealthPartners Institute. 8170 33 Ave S., Minneapolis, Minnesota 55425, USA
- University of Minnesota Medical School. 420 Delaware St SE, Minneapolis, Minnesota, 55455, USA
| | - Stephanie A Hooker
- HealthPartners Institute. 8170 33 Ave S., Minneapolis, Minnesota 55425, USA
- University of Minnesota Medical School. 420 Delaware St SE, Minneapolis, Minnesota, 55455, USA
| | - A Lauren Crain
- HealthPartners Institute. 8170 33 Ave S., Minneapolis, Minnesota 55425, USA
| | - Patrick J O'Connor
- HealthPartners Institute. 8170 33 Ave S., Minneapolis, Minnesota 55425, USA
- University of Minnesota Medical School. 420 Delaware St SE, Minneapolis, Minnesota, 55455, USA
| | - Jacob L Haapala
- HealthPartners Institute. 8170 33 Ave S., Minneapolis, Minnesota 55425, USA
| | - David J Bond
- Johns Hopkins University, Department of Psychiatry and Behavioral Sciences. 600 N Wolfe St., Baltimore, Maryland 21205, USA
| | - Rebecca C Rossom
- HealthPartners Institute. 8170 33 Ave S., Minneapolis, Minnesota 55425, USA
- University of Minnesota Medical School. 420 Delaware St SE, Minneapolis, Minnesota, 55455, USA
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Romeo B, Fauvel B, Dejean S, Strika L, Amirouche A, Verroust V, Piolino P, Benyamina A. Impact of a Naturalistic Psychedelic Experience on Smoking: A Retrospective Survey. J Psychoactive Drugs 2023; 55:640-649. [PMID: 37341764 DOI: 10.1080/02791072.2023.2227171] [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: 10/01/2022] [Revised: 04/17/2023] [Accepted: 05/01/2023] [Indexed: 06/22/2023]
Abstract
Tobacco use disorder is a major public health concern. The aim of this study was to investigate the impact of a psychedelic experience in a natural context on tobacco use. A retrospective online survey was conducted on 173 individuals who reported having had a psychedelic experience while being smokers. Demographic information was collected, and characteristics of the psychedelic experience, tobacco addiction and psychological flexibility were assessed. Mean number of cigarettes smoked per day, and proportion of individuals with high tobacco dependency significantly decreased between the three time points (p < .001). Participants who reduced or quit smoking had more intense mystical experiences during the psychedelic session (p = .01) and lower psychological flexibility before the psychedelic experience (p = .018). The increase in psychological flexibility post psychedelic session, and the personal motives for the psychedelic experience were significant positive predictors of smoking reduction or cessation (p < .001). Our results confirmed that a psychedelic experience in smoker individuals can be associated with smoking and tobacco dependency reduction and that the personal motives for the psychedelic session, the intensity of the mystical experience, and the increase of psychological flexibility following the psychedelic experience, are associated with smoking cessation or reduction.
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Affiliation(s)
- B Romeo
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France
- Unité de Recherche Psychiatrie-Comorbidités-Addictions - PSYCOMADD -Paris Saclay University Île-de-France, Villejuif, France
| | - B Fauvel
- Laboratoire Mémoire, Cerveau Et Cognition (UR 7536), Institut de Psychologie, Université de Paris Cité, Paris, France
| | - S Dejean
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France
| | - L Strika
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France
- Unité de Recherche Psychiatrie-Comorbidités-Addictions - PSYCOMADD -Paris Saclay University Île-de-France, Villejuif, France
| | - A Amirouche
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France
- Unité de Recherche Psychiatrie-Comorbidités-Addictions - PSYCOMADD -Paris Saclay University Île-de-France, Villejuif, France
| | - V Verroust
- Unité de Recherche Psychiatrie-Comorbidités-Addictions - PSYCOMADD -Paris Saclay University Île-de-France, Villejuif, France
- Centre d'histoire des sciences, des sociétés et des conflits, Université Picardie-Jules Vernes, Amiens, France
| | - P Piolino
- Laboratoire Mémoire, Cerveau Et Cognition (UR 7536), Institut de Psychologie, Université de Paris Cité, Paris, France
| | - A Benyamina
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France
- Unité de Recherche Psychiatrie-Comorbidités-Addictions - PSYCOMADD -Paris Saclay University Île-de-France, Villejuif, France
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