Considering Metabolism Key in Prescribing Effective Smoking Cessation Treatments

An optimal cessation treatment gauged how quickly a smoker metabolized nicotine after quitting, according to researchers at the University of Pennsylvania.

Looking at 1,246 smokers seeking to quit, the researchers determined whether they had a normal or low nicotine metabolite ratio (NMR). From there, the subjects were randomly administered a placebo (n=408), nicotine patch (n=428) or varenicline (n=420). The patients were studied for 12 months following the date they quit.

Although varenicline, also known as Chantix, was more effective than the patch and placebo in normal NMR participants (OR 2·17, 95% CI 1·38—3·42; p=0·001), the treatment was not as successful in slow metabolizers (OR 1·13, 0·74–1·71; p=0·56). The authors determined the patch as favorable, since they experienced more side effects from varencile (β=–1·06, 95% CI −2·08 to −0·03; p=0·044).

“Treating normal metabolizers with varenicline and slow metabolizers with nicotine patch could optimise quit rates while minimising side-effects,” the investigators recommended in The Lancet Respiratory Medicine.

By the end of the treatment period, the statement also noted that almost 40 and 22% of normal NMR subjects had successfully abstained from smoking while prescribed varenicline or the patch, respectively. As the authors anticipated, there was, in fact, a drop off after 6 and 12 months, however the ratios for the studied patients remained the same.

“These findings not only support the use of the nicotine metabolite ratio as a biomarker to guide treatment choices,” Lerman said in a statement, “but also underscore the notion that tobacco dependence is a heterogeneous condition and that smoking cessation treatments are not equally effective for all smokers.”