Individualizing nicotine replacement therapy for the treatment of tobacco dependence
Individualizing nicotine replacement therapy for the treatment of tobacco dependence
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DOI：
10.7326/0003-4819-140-6-200403160-00009
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发表时间：
2004-03-16
影响因子：
39.2
通讯作者：
Benowitz, N
中科院分区：
文献类型：
--
作者：
Lerman, C;Kaufmann, V;Benowitz, N
背景：尽管不同形式的尼古丁替代疗法的疗效以及不同的药代动力学和药效学特性都有据可查，但经验数据不足以指导从业者为个体烟草依赖患者选择特定的治疗形式。目的：评估透皮尼古丁和尼古丁鼻喷雾剂的比较疗效，并确定治疗结果的预测因素。设计：随机、开放标签临床试验，随访期为 6 个月。背景：2 所大学的戒烟研究项目。参与者：299 名寻求治疗的吸烟者，在目标戒烟日期后随访 6 个月。干预：行为小组咨询和 8 周尼古丁鼻喷雾剂或透皮尼古丁治疗。测量：在基线时测量人口统计学特征、吸烟史、抑郁症状和体重指数。在治疗结束时和目标戒烟日期后 6 个月对吸烟习惯进行生化验证。结果：6 个月随访时，透皮尼古丁组和尼古丁鼻喷雾剂组的戒烟率没有显着差异（分别为 15.0% 和 12.2%；P > 0.2）。吸烟者亚组戒烟率的交互作用具有统计学意义（P < 0.05）。低至中度依赖程度、不肥胖和白人的吸烟者对透皮尼古丁的戒断率较高，而高度依赖、肥胖或少数群体成员的吸烟者则通过鼻喷雾剂实现了较高的戒断率。 局限性：亚组研究结果在常规应用之前需要在更多大型研究中得到证实。结论：种族、体重和尼古丁依赖程度可能有助于识别透皮尼古丁或尼古丁尼古丁戒断率较高或较低的吸烟者。鼻喷雾尼古丁。
Background: Despite the well-documented efficacy and different pharmacokinetic and pharmacodynamic properties of different forms of nicotine replacement therapy, empirical data are insufficient to guide practitioners in selecting a particular form of treatment for individual patients with tobacco dependence.Objective: To evaluate the comparative efficacy of transdermal nicotine and nicotine nasal spray and identify predictors of treatment outcome.Design: Randomized, open-label clinical trial with a 6-month follow-up period.Setting: 2 university-based smoking cessation research programs.Participants: 299 treatment-seeking smokers who were followed for 6 months after the target quit date.Intervention: Behavioral group counseling and 8 weeks of therapy with nicotine nasal spray or transdermal nicotine.Measurements: Demographic characteristics, smoking history, depression symptoms, and body mass index were measured at baseline. Smoking practices were biochemically verified at the end of treatment and at 6 months after the target quit date.Results: Abstinence rates for the transdermal nicotine and nicotine nasal spray groups were not significantly different at 6-month follow-up (15.0% vs. 12.2%, respectively; P > 0.2). Interactions in abstinence rates for subgroups of smokers were statistically significant (P < 0.05). Smokers who had low to moderate dependence levels, were not obese, and were white achieved higher abstinence rates with transdermal nicotine, whereas smokers who were highly dependent, obese, or members of minority groups achieved higher abstinence rates with nasal spray.Limitations: The subgroup findings need confirmation in additional large studies before they are routinely applied.Conclusions: Ethnicity, weight, and level of nicotine dependence may help identify smokers who have greater or lesser abstinence rates with either transdermal or nasal spray nicotine.