Comparative Effectiveness of 5 Smoking Cessation Pharmacotherapies in Primary Care Clinics
Comparative Effectiveness of 5 Smoking Cessation Pharmacotherapies in Primary Care Clinics
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DOI：
10.1001/archinternmed.2009.426
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发表时间：
2009-12-14
影响因子：
--
通讯作者：
Jackson, Thomas C.
中科院分区：
文献类型：
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作者：
Smith, Stevens S.;McCarthy, Danielle E.;Jackson, Thomas C.
背景：在研究环境中进行的随机疗效临床试验可能不能准确地反映烟草依赖治疗在现实世界临床环境中使用的益处。需要进行有效性试验(例如，在初级保健环境中)来评估实际使用的戒烟治疗的益处。方法：12个初级保健诊所的医务助理招募了1346名参加常规预约的初级保健患者。患者被随机分为5种有效药物疗法：3种单一疗法(尼古丁贴片、尼古丁含片和盐酸安非他酮缓释片)和2种联合疗法(贴剂+含片和安非他酮缓释片+含片)。患者被推荐到电话戒烟专线进行戒烟咨询。主要结果包括戒烟后第1周、第8周和第6个月的7天戒烟率和戒烟天数。结果：在参加常规初级保健预约的7128名符合条件的吸烟者中，1346人(18.9%)进入研究。5种药物的6个月戒断率分别为：安非他酮缓释片16.8%、含片19.9%、贴片17.7%、贴片+含片26.9%、安非他酮缓释片+含片29.9%。安非他酮SR+含片优于所有单一疗法(优势比为0.46-0.56)；贴片+含片优于贴剂和安非他酮单一疗法(优势比分别为0.56和0.54)。结论：参加常规初级保健预约的吸烟者中，每5人中就有1人愿意进行认真的戒烟尝试，包括循证咨询和药物治疗。在这项对5种烟草依赖治疗方法的比较有效性研究中，与单一疗法相比，联合药物疗法显著增加了戒烟率。提供免费戒烟药物，加上在初级保健环境中安排的戒烟线咨询，有望帮助大量吸烟者戒烟。
Background: Randomized efficacy clinical trials conducted in research settings may not accurately reflect the benefits of tobacco dependence treatments when used in real-world clinical settings. Effectiveness trials (eg, in primary care settings) are needed to estimate the benefits of cessation treatments in real-world use.Methods: A total of 1346 primary care patients attending routine appointments were recruited by medical assistants in 12 primary care clinics. Patients were randomly assigned to 5 active pharmacotherapies: 3 monotherapies (nicotine patch, nicotine lozenge, and bupropion hydrochloride sustained release [SR]) and 2 combination therapies (patch + lozenge and bupropion SR + lozenge). Patients were referred to a telephone quit line for cessation counseling. Primary outcomes included 7-day point prevalence abstinence at I week, 8 weeks, and 6 months after quitting and number of days to relapse.Results: Among 7128 eligible smokers (>= 10 cigarettes per day) attending routine primary care appointments, 1346 (18.9%) were enrolled in the study. Six-month abstinence rates for the 5 active pharmacotherapies were the following: bupropion SR, 16.8%; lozenge, 19.9%; patch, 17.7%; patch + lozenge, 26.9%; and bupropion SR + lozenge, 29.9%. Bupropion SR + lozenge was superior to all of the monotherapies (odds ratio, 0.46-0.56); patch + lozenge was superior to patch and bupropion monotherapies (odds ratio, 0.56 and 0.54, respectively).Conclusions: One in 5 smokers attending a routine primary care appointment was willing to make a serious quit attempt that included evidence-based counseling and medication. In this comparative effectiveness study of 5 tobacco dependence treatments, combination pharmacotherapy significantly increased abstinence compared with monotherapies. Provision of free cessation medications plus quit line counseling arranged in the primary care setting holds promise for assisting large numbers of smokers to quit.