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      • Record: found
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      Comparative Effectiveness of Smoking Cessation Medications: A National Prospective Cohort From Taiwan

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          Abstract

          Background and objective

          Relative effectiveness of smoking cessation medications—varenicline, bupropion and nicotine replacement therapy (NRT)—remains unclear among smokers in real-world settings. Evidence in females and smokers with light/moderate nicotine dependence is particularly insufficient. This study compared the effectiveness of varenicline, bupropion or NRT gum relative to NRT patch, in achieving abstinence among recent quitters.

          Methods

          In a national smoking cessation program in Taiwan (2012–2015), a cohort of 11,968 participants received varenicline (n = 5,052), bupropion (n = 823), NRT gum (n = 1944) or NRT patch (n = 4,149). The 7-day, 1-month or 6-month point-prevalence was calculated based on self-reported last smoking event via telephone interview after 6 months. Logistic regression modellings estimated odds ratios (OR) and 95% confidence intervals (CI) for achieving abstinence using different modalities (NRT patch as referent). Models included age, sex, education, marital status, geographic region, smoke-years, nicotine-dependence level, medical institution, number of clinic visits and medication use duration. Analyses were further stratified by sex and dependence severity.

          Results

          Participants were predominantly male (83%) with a mean age of 43.7±12.6 years. Varenicline users were more likely than NRT patch users to achieve abstinence, based on 7-day point-prevalence (OR = 1.30, CI: 1.19–1.44), 1-month point-prevalence (OR = 1.36, CI: 1.24–1.50) or 6-month point-prevalence (OR = 1.30, CI: 1.14–1.47). Compared with NRT patch, varenicline was associated with greater odds of being abstinent in women (OR = 1.29, CI: 1.01–1.65), men (OR = 1.31, CI: 1.18–1.46), those with light/moderate dependence (OR = 1.42, CI: 1.24–1.63) or smokers with severe dependence (OR = 1.19, CI: 1.04–1.37), based on 7-day point-prevalence. Differences in effectiveness were not observed between users of bupropion, NRT gum and NRT patch.

          Conclusions

          In smoking cessation clinics in Taiwan, varenicline users reported higher abstinence rates than NRT patch users after 6 months. Women and smokers with light/moderate nicotine dependence may also benefit from varenicline in actual clinical practice.

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          Most cited references16

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          21st-Century Hazards of Smoking and Benefits of Cessation in the United States

          Prabhat Jha, Chinthanie Ramasundarahettige, Victoria Landsman … (2013)
          Extrapolation from studies in the 1980s suggests that smoking causes 25% of deaths among women and men 35 to 69 years of age in the United States. Nationally representative measurements of the current risks of smoking and the benefits of cessation at various ages are unavailable. We obtained smoking and smoking-cessation histories from 113,752 women and 88,496 men 25 years of age or older who were interviewed between 1997 and 2004 in the U.S. National Health Interview Survey and related these data to the causes of deaths that occurred by December 31, 2006 (8236 deaths in women and 7479 in men). Hazard ratios for death among current smokers, as compared with those who had never smoked, were adjusted for age, educational level, adiposity, and alcohol consumption. For participants who were 25 to 79 years of age, the rate of death from any cause among current smokers was about three times that among those who had never smoked (hazard ratio for women, 3.0; 99% confidence interval [CI], 2.7 to 3.3; hazard ratio for men, 2.8; 99% CI, 2.4 to 3.1). Most of the excess mortality among smokers was due to neoplastic, vascular, respiratory, and other diseases that can be caused by smoking. The probability of surviving from 25 to 79 years of age was about twice as great in those who had never smoked as in current smokers (70% vs. 38% among women and 61% vs. 26% among men). Life expectancy was shortened by more than 10 years among the current smokers, as compared with those who had never smoked. Adults who had quit smoking at 25 to 34, 35 to 44, or 45 to 54 years of age gained about 10, 9, and 6 years of life, respectively, as compared with those who continued to smoke. Smokers lose at least one decade of life expectancy, as compared with those who have never smoked. Cessation before the age of 40 years reduces the risk of death associated with continued smoking by about 90%.
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            Sex differences in long-term smoking cessation rates due to nicotine patch.

            Kenneth Perkins, John Scott (2008)
            Compared to men, women may be at greater risk for smoking-related diseases and have greater difficulty quitting smoking. Sex differences in medication response could guide treatment for smoking cessation to improve women's quit rates. We conducted a meta-analysis of the 14 placebo-controlled nicotine patch trials (N = 6,250) for which long-term (6 months) clinical outcome results could be determined separately by sex. This analysis updated a meta-analysis of 11 of these trials that found no significant sex differences due to nicotine patch. The increase in quitting due to the nicotine vs. placebo patch was only about half as large in women as in men. Pooled absolute quit rates at 6 months for nicotine and placebo patch, respectively, were 20.1% and 10.8% in men, and 14.7% and 10.1% in women. The odds ratio for quitting due to nicotine vs. placebo patch was lower in women (OR = 1.61) than in men (OR = 2.20), with an interaction odds ratio of 1.40 (95% CI = 1.02-1.93, p = .04). This sex difference did not vary significantly by whether or not formal counseling was provided. Poorer outcomes in women vs. men treated with nicotine patch suggests that increasing the quit rates of women smokers may require supplementing patch treatment or use of other medications.
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              Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force.

              Carrie Patnode, Jillian Henderson, Jamie H Thompson … (2015)
              Tobacco use is the leading cause of preventable death in the United States.
              Article 0 comments Cited 64 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Bernard Le Foll: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 28 November 2016
                Publication date Collection: 2016
                Volume: 11
                Issue: 11
                Electronic Location Identifier: e0166992
                Affiliations
                [1 ]Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
                [2 ]Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
                [3 ]Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
                Centre for Addiction and Mental Health, CANADA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: PYC PCL KCH YWT.

                • Data curation: HCC.

                • Formal analysis: PCL HCC YWT.

                • Funding acquisition: KCH YWT.

                • Methodology: PYC PCL YWT.

                • Project administration: YWT.

                • Resources: KCH YWT.

                • Software: PCL HCC YWT.

                • Supervision: KCH YWT.

                • Validation: HCC YWT.

                • Visualization: PCL HCC.

                • Writing – original draft: PYC PCL.

                • Writing – review & editing: YWT.

                Article
                Publisher ID: PONE-D-16-19187
                DOI: 10.1371/journal.pone.0166992
                PMC ID: 5125644
                PubMed ID: 27893843
                SO-VID: d236d6fa-fdf6-413a-a09a-6aeddc0158b9
                Copyright © © 2016 Chang et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 11 May 2016
                Date accepted : 7 November 2016
                Page count
                Figures: 2, Tables: 2, Pages: 13
                Funding
                Funded by: Health Promotion Administration, Taiwan
                Award ID: G1031227-105
                Award Recipient :
                Funded by: Health Promotion Administration, Taiwan
                Award ID: G1031227-105
                Award Recipient :
                Funded by: Health Promotion Administration, Taiwan
                Award ID: G1031227-105
                Award Recipient :
                Funded by: Health Promotion Administration, Taiwan
                Award ID: G1031227-105
                Award Recipient :
                National Yang-Ming University received research funding from the revenues of tobacco health and welfare surcharges by the Health Promotion Administration, Ministry of Health and Welfare, Taiwan, for project, titled “International Collaborative Project for the Evaluation of Medical Services for Smoking Cessation.” Yi-Wen Tsai (PI), Kuang-Chieh Hsueh (Co-PI), Po-Yin Chang, Po-Ching Lo and Hui-Chin Chang received grants (G1031227-105) from the Health Promotion Administration, Ministry of Health and Welfare, Taiwan ( http://www.hpa.gov.tw/BHPNet/English/Index.aspx). Health Promotion Administration, Taiwan provided data for the current study; it had no role in study design, analysis, data interpretation, or manuscript writing.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Pharmaceutics
                Subject: Drug Therapy
                Subject: Neurological Drug Therapy
                Subject: Anti-Addiction Drug Therapy
                Subject: Nicotine Replacement Therapy
                Subject: Biology and Life Sciences
                Subject: Behavior
                Subject: Habits
                Subject: Smoking Habits
                Subject: Medicine and Health Sciences
                Subject: Pharmaceutics
                Subject: Drug Therapy
                Subject: People and Places
                Subject: Geographical Locations
                Subject: Asia
                Subject: Taiwan
                Subject: Research and Analysis Methods
                Subject: Research Design
                Subject: Clinical Research Design
                Subject: Comparative Effectiveness Research
                Subject: Social Sciences
                Subject: Sociology
                Subject: Education
                Subject: Schools
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Care Facilities
                Subject: Outpatient Clinics
                Subject: Biology and Life Sciences
                Subject: Psychology
                Subject: Addiction
                Subject: Nicotine Addiction
                Subject: Social Sciences
                Subject: Psychology
                Subject: Addiction
                Subject: Nicotine Addiction
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: Substance-Related Disorders
                Subject: Nicotine Addiction
                Subject: Medicine and Health Sciences
                Subject: Public and Occupational Health
                Subject: Substance-Related Disorders
                Subject: Nicotine Addiction
                Custom metadata
                Data Availability Health Promotion Administration, Taiwan provided data for the current study. Authors do not own the data. Data are available upon request to Health Promotion Administration, Ministry of Health and Welfare, Taiwan, for researchers who meet the criteria for access to confidential data. Interested readers may also contact Professor Yi-Wen Tsai to request the data set. Yi-Wen Tsai's email address: ywtsai@ 123456ym.edu.tw .

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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