Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 313
Filtrar
2.
JAMA Netw Open ; 4(1): e2032053, 2021 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-33464316

RESUMEN

Importance: Understanding Black vs White differences in pharmacotherapy efficacy and the underlying reasons is critically important to reducing tobacco-related health disparities. Objective: To compare pharmacotherapy efficacy and examine variables to explain Black vs White differences in smoking abstinence. Design, Setting, and Participants: This study is a secondary analysis of the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) double-blind, placebo-controlled, randomized clinical trial, which took place at clinical trial centers, academic centers, and outpatient clinics in 29 states in the US. US Black and White smokers who smoked 10 or more cigarettes per day with and without psychiatric comorbidity were enrolled between November 2011 and January 2015. Data analysis was performed from July 2019 to January 2020. Interventions: Participants were randomized (1:1:1:1) in a double-blind, triple-dummy, placebo- and active-controlled (nicotine patch) trial of varenicline and bupropion for 12 weeks with follow-up through week 24. Main Outcomes and Measures: Biochemically verified continuous cigarette abstinence rate (CAR) from weeks 9 to 24. Baseline, postbaseline treatment, and safety characteristics were examined as variables to explain race differences in abstinence. Results: Of the 1065 Black smokers enrolled, 255 were randomized to receive varenicline, 259 received bupropion, 286 received nicotine replacement therapy (NRT [ie, nicotine patch]), and 265 received placebo. Among the 3044 White smokers enrolled, 778 were randomized to receive varenicline, 769 received bupropion, 738 received NRT, and 759 received placebo. Participants were predominantly female (614 Black [57.7%] and 1786 White [58.7%] women) and heavy smokers (mean [SD] cigarettes per day, 18.2 [7.9] for Black and 20.0 [7.5] for White smokers), with a mean (SD) age of 47.2 (11.2) years for Black and 46.5 (12.7) years for White participants. Treatment and race were associated with CAR for weeks 9 to 24. The CAR was 4.9% lower for Black vs White participants (odds ratio [OR], 0.53; 95% CI, 0.41-0.69; P < .001); differences were found across all treatments. Pooling psychiatric and nonpsychiatric cohorts, varenicline (OR, 2.63; 95% CI, 1.90-3.63; P < .001), bupropion (OR, 1.75; 95% CI, 1.25-2.46; P = .001), and NRT (OR, 1.52; 95% CI, 1.07-2.16; P = .02) had greater efficacy than placebo for White participants. Only varenicline (OR, 2.63; 95% CI, 1.26-5.48; P = .01) had greater efficacy than placebo for Black participants. Baseline, postbaseline, and safety characteristics differed by race, but these variables did not eliminate the association of race with CAR. Black participants had 49% reduced odds of CAR for weeks 9 to 24 compared with White participants in the adjusted model (OR, 0.51; 95% CI, 0.39-0.66; P < .001). Conclusions and Relevance: Black and White smokers achieved the highest rate of abstinence while taking varenicline, suggesting that it is the best first-line therapy for these groups. However, Black smokers were less responsive to all therapies, including placebo. Understanding variables (eg, socioeconomic or biological) beyond those may lead to improved treatment outcomes for Black smokers. Trial Registration: ClinicalTrials.gov Identifier: NCT01456936.


Asunto(s)
Bupropión/uso terapéutico , Agonistas Nicotínicos/uso terapéutico , Factores Raciales , Agentes para el Cese del Hábito de Fumar/uso terapéutico , Cese del Hábito de Fumar/etnología , Vareniclina/uso terapéutico , Grupo de Ascendencia Continental Africana , Método Doble Ciego , Grupo de Ascendencia Continental Europea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dispositivos para Dejar de Fumar Tabaco
5.
JAMA ; 324(14): 1406-1418, 2020 10 13.
Artículo en Inglés | MEDLINE | ID: mdl-33048154

RESUMEN

Importance: Persistent smoking may cause adverse outcomes among patients with cancer. Many cancer centers have not fully implemented evidence-based tobacco treatment into routine care. Objective: To determine the effectiveness of sustained telephone counseling and medication (intensive treatment) compared with shorter-term telephone counseling and medication advice (standard treatment) to assist patients recently diagnosed with cancer to quit smoking. Design, Setting, and Participants: This unblinded randomized clinical trial was conducted at Massachusetts General Hospital/Dana-Farber/Harvard Cancer Center and Memorial Sloan Kettering Cancer Center. Adults who had smoked 1 cigarette or more within 30 days, spoke English or Spanish, and had recently diagnosed breast, gastrointestinal, genitourinary, gynecological, head and neck, lung, lymphoma, or melanoma cancers were eligible. Enrollment occurred between November 2013 and July 2017; assessments were completed by the end of February 2018. Interventions: Participants randomized to the intensive treatment (n = 153) and the standard treatment (n = 150) received 4 weekly telephone counseling sessions and medication advice. The intensive treatment group also received 4 biweekly and 3 monthly telephone counseling sessions and choice of Food and Drug Administration-approved cessation medication (nicotine replacement therapy, bupropion, or varenicline). Main Outcome and Measures: The primary outcome was biochemically confirmed 7-day point prevalence tobacco abstinence at 6-month follow-up. Secondary outcomes were treatment utilization rates. Results: Among 303 patients who were randomized (mean age, 58.3 years; 170 women [56.1%]), 221 (78.1%) completed the trial. Six-month biochemically confirmed quit rates were 34.5% (n = 51 in the intensive treatment group) vs 21.5% (n = 29 in the standard treatment group) (difference, 13.0% [95% CI, 3.0%-23.3%]; odds ratio, 1.92 [95% CI, 1.13-3.27]; P < .02). The median number of counseling sessions completed was 8 (interquartile range, 4-11) in the intensive treatment group. A total of 97 intensive treatment participants (77.0%) vs 68 standard treatment participants (59.1%) reported cessation medication use (difference, 17.9% [95% CI, 6.3%-29.5%]; odds ratio, 2.31 [95% CI, 1.32-4.04]; P = .003). The most common adverse events in the intensive treatment and standard treatment groups, respectively, were nausea (n = 13 and n = 6), rash (n = 4 and n = 1), hiccups (n = 4 and n = 1), mouth irritation (n = 4 and n = 0), difficulty sleeping (n = 3 and n = 2), and vivid dreams (n = 3 and n = 2). Conclusions and Relevance: Among smokers recently diagnosed with cancer in 2 National Cancer Institute-designated Comprehensive Cancer Centers, sustained counseling and provision of free cessation medication compared with 4-week counseling and medication advice resulted in higher 6-month biochemically confirmed quit rates. However, the generalizability of the study findings is uncertain and requires further research. Trial Registration: ClinicalTrials.gov Identifier: NCT01871506.


Asunto(s)
Consejo/métodos , Neoplasias/diagnóstico , Cese del Hábito de Fumar/psicología , Templanza/psicología , Dispositivos para Dejar de Fumar Tabaco , Anciano , Bupropión/efectos adversos , Bupropión/uso terapéutico , Cotinina/análisis , Consejo/estadística & datos numéricos , Técnicas de Apoyo para la Decisión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Entrevista Motivacional , Satisfacción del Paciente , Selección de Paciente , Saliva/química , Fumar/tratamiento farmacológico , Fumar/epidemiología , Fumar/psicología , Agentes para el Cese del Hábito de Fumar/efectos adversos , Agentes para el Cese del Hábito de Fumar/uso terapéutico , Teléfono , Dispositivos para Dejar de Fumar Tabaco/efectos adversos , Vareniclina/efectos adversos , Vareniclina/uso terapéutico
7.
J Stud Alcohol Drugs ; 81(4): 426-435, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32800078

RESUMEN

OBJECTIVE: Heavy drinking is common among smokers and is associated with especially poor health outcomes. Varenicline may affect mechanisms and clinical outcomes that are relevant for both smoking cessation and alcohol use. The current study examines whether varenicline, relative to nicotine replacement therapy, yields better smoking cessation outcomes among binge drinking smokers. METHOD: Secondary data analyses of a comparative effectiveness randomized controlled trial of three smoking cessation pharmacotherapies (12 weeks of varenicline, nicotine patch, or nicotine patch and lozenge) paired with six counseling sessions were conducted. Adult daily cigarette smokers (N = 1,078, 52% female) reported patterns of alcohol use, cigarette craving, and alcohol-related cigarette craving at baseline and over 4 weeks after quitting. Smoking cessation outcome was 7-day biochemically confirmed point-prevalence abstinence. RESULTS: Binge drinkers had higher relapse rates than moderate drinkers at 4-week post-target quit day but not at the end of treatment or long-term follow up (12 and 26 weeks). Varenicline did not yield superior smoking cessation outcomes among binge drinkers, nor did it affect alcohol use early in the quit attempt. Varenicline did produce relatively large reductions in alcohol-related cigarette craving and overall cigarette craving during the first 4 weeks after quitting. CONCLUSIONS: Varenicline did not yield higher smoking abstinence rates or reduce alcohol use among binge drinkers. Varenicline did reduce alcohol-related cigarette craving but this did not translate to meaningful differences in smoking abstinence. Varenicline's effects on smoking abstinence do not appear to vary significantly as a function of drinking status.


Asunto(s)
Borrachera/psicología , Medicina de Precisión , Cese del Hábito de Fumar/métodos , Dispositivos para Dejar de Fumar Tabaco , Vareniclina/uso terapéutico , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fumadores
8.
J Subst Abuse Treat ; 117: 108100, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32811627

RESUMEN

Clinical trials represent an essential component of improving treatment for substance use disorders (SUD). The SARS coronavirus-2 pandemic disrupted our ongoing clinical trial of smoking cessation and forced us to rapidly implement changes to assure participants access to ongoing counseling and monitoring via telephone calls and/or video chat sessions. Our experiences suggest that this pandemic will lead to changes for both future clinical trial participants and project staff. While challenges remain, it will be important to assessing the impact of these changes with regard to participant experiences and treatment outcomes.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Consejo , Pandemias , Neumonía Viral/complicaciones , Cese del Hábito de Fumar , Teléfono , Adulto , Betacoronavirus/aislamiento & purificación , Ensayos Clínicos como Asunto , Femenino , Humanos , Internet , Masculino , Agentes para el Cese del Hábito de Fumar/uso terapéutico , Trastornos Relacionados con Sustancias , Resultado del Tratamiento , Vareniclina/uso terapéutico
9.
Am J Respir Crit Care Med ; 202(2): e5-e31, 2020 07 15.
Artículo en Inglés | MEDLINE | ID: mdl-32663106

RESUMEN

Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams.Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations.Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes.Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.


Asunto(s)
Bupropión/normas , Guías de Práctica Clínica como Asunto , Agentes para el Cese del Hábito de Fumar/normas , Tabaquismo/tratamiento farmacológico , Vareniclina/normas , Adulto , Anciano , Anciano de 80 o más Años , Bupropión/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Agentes para el Cese del Hábito de Fumar/uso terapéutico , Estados Unidos , Vareniclina/uso terapéutico
10.
High Blood Press Cardiovasc Prev ; 27(5): 349-362, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32578165

RESUMEN

Tobacco use is one of the major public health concerns and it is the most preventable cause of morbidity and mortality worldwide. Smoking cessation reduces subsequent cardiovascular events and mortality. Smoking is a real chronic disorder characterized by the development of an addiction status mainly due to nicotine. This condition makes the smokers generally unable to quit smoking without help. Different strategies are available to treat smoking dependence that include both non-pharmacological (behavioral counselling) and pharmacological therapies. Currently, it is well accepted that smoking cessation drugs are effective and safe in real-world settings. Nicotine replacement therapy (NRT), varenicline, bupropion and cytisine are the main pharmacological strategies available for smoking cessation. Their efficacy and safety have been proved even in patients with chronic cardiovascular disease. Each of these drugs has peculiar characteristics and the clinician should customize the smoking cessation strategy based on currently available scientific evidence and patient's preference, paying particular attention to those patients having specific cardiovascular and psychiatric comorbidities. The present document aims to summarize the current viable pharmacological strategies for smoking cessation, also discussing the controversial issue regarding the use of alternative tobacco products, in order to provide useful practical indications to all physicians, mainly to those involved in cardiovascular prevention.


Asunto(s)
Alcaloides/uso terapéutico , Bupropión/uso terapéutico , Agentes para el Cese del Hábito de Fumar/uso terapéutico , Cese del Hábito de Fumar , Fumar/efectos adversos , Tabaquismo/tratamiento farmacológico , Vareniclina/uso terapéutico , Alcaloides/efectos adversos , Azocinas/efectos adversos , Azocinas/uso terapéutico , Bupropión/efectos adversos , Toma de Decisiones Clínicas , Sistemas Electrónicos de Liberación de Nicotina , Humanos , Quinolizinas/efectos adversos , Quinolizinas/uso terapéutico , Recurrencia , Factores de Riesgo , Agentes para el Cese del Hábito de Fumar/efectos adversos , Dispositivos para Dejar de Fumar Tabaco , Tabaquismo/diagnóstico , Tabaquismo/fisiopatología , Tabaquismo/psicología , Resultado del Tratamiento , Vareniclina/efectos adversos
11.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(6): 890-895, 2020 Jun 10.
Artículo en Chino | MEDLINE | ID: mdl-32564555

RESUMEN

Objective: To evaluate the effect of smoking cessation project run by the Central Subsidy Smoking Cessation Clinic and to explore the related influencing factors on smoking cessation, in order to improve related services and provide better guidance to these smoking cessation clinics. Methods: Practitioners who had been trained to run smoking cessation projects were recruited to conduct face-to-face interview with the smokers. Questionnaires were completed to provide information on related psychological, social and behavioral issues. In these clinics, medications were provided to the patients by the health care takers in the clinic. One month after the first visit, smoking cessation rate (self-reported, 7-day point prevalence abstinence rate at 30-day follow-up) was counted. Results: The overall smoking cessation rate (self-reported, 7-day point prevalence abstinence rate at 30-day follow-up) appeared as 34.1%. Results from the multivariate logistic regression showed that patients over the age of 60 were the ones most likely to quit smoking. Smokers who showed higher possibility of quitting would include those: not on the daily base, intend to quit within 30 days, with other diseases, or taking varenicline and bupropion. Factors as unemployment, longer history of smoking, bigger quantity of cigarettes consumption per day, dependence on nicotine and urgency on taking up the first cigarette in the early morning etc., were related to the less likelihood of giving up smoking. However, histories of cessation did not seem to affect the possibility of quitting. Conclusions: Data from self-reported 7-day point prevalence abstinence at 30-day follow-up study showed that the smoking cessation intervention programs run by the central subsidy smoking cessation clinic project had been effectively implemented. Advocacy on quit smoking at early stage seemed to have better outcomes, thus should be called for. Since medications as varenicline tartrate and bupropion hydrochloride can increase the possibility of stop smoking, we would suggest that all the hospitals which are with smoking cessation clinics be equipped with these medicines. Professional assistance provided by practitioners is of key importance to help overcome the withdrawal symptoms during the periods of cessation, on these smokers.


Asunto(s)
Pacientes Ambulatorios/psicología , Cese del Hábito de Fumar/estadística & datos numéricos , Bupropión/uso terapéutico , China , Estudios de Seguimiento , Humanos , Pacientes Ambulatorios/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Encuestas y Cuestionarios , Vareniclina/uso terapéutico
13.
Cochrane Database Syst Rev ; 4: CD000031, 2020 04 22.
Artículo en Inglés | MEDLINE | ID: mdl-32319681

RESUMEN

BACKGROUND: Whilst the pharmacological profiles and mechanisms of antidepressants are varied, there are common reasons why they might help people to stop smoking tobacco. Firstly, nicotine withdrawal may produce depressive symptoms and antidepressants may relieve these. Additionally, some antidepressants may have a specific effect on neural pathways or receptors that underlie nicotine addiction. OBJECTIVES: To assess the evidence for the efficacy, safety and tolerability of medications with antidepressant properties in assisting long-term tobacco smoking cessation in people who smoke cigarettes. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Specialized Register, which includes reports of trials indexed in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO, clinicaltrials.gov, the ICTRP, and other reviews and meeting abstracts, in May 2019. SELECTION CRITERIA: We included randomized controlled trials (RCTs) that recruited smokers, and compared antidepressant medications with placebo or no treatment, an alternative pharmacotherapy, or the same medication used in a different way. We excluded trials with less than six months follow-up from efficacy analyses. We included trials with any follow-up length in safety analyses. DATA COLLECTION AND ANALYSIS: We extracted data and assessed risk of bias using standard Cochrane methods. We also used GRADE to assess the certainty of the evidence. The primary outcome measure was smoking cessation after at least six months follow-up, expressed as a risk ratio (RR) and 95% confidence intervals (CIs). We used the most rigorous definition of abstinence available in each trial, and biochemically validated rates if available. Where appropriate, we performed meta-analysis using a fixed-effect model. Similarly, we presented incidence of safety and tolerance outcomes, including adverse events (AEs), serious adverse events (SAEs), psychiatric AEs, seizures, overdoses, suicide attempts, death by suicide, all-cause mortality, and trial dropout due to drug, as RRs (95% CIs). MAIN RESULTS: We included 115 studies (33 new to this update) in this review; most recruited adult participants from the community or from smoking cessation clinics. We judged 28 of the studies to be at high risk of bias; however, restricting analyses only to studies at low or unclear risk did not change clinical interpretation of the results. There was high-certainty evidence that bupropion increased long-term smoking cessation rates (RR 1.64, 95% CI 1.52 to 1.77; I2 = 15%; 45 studies, 17,866 participants). There was insufficient evidence to establish whether participants taking bupropion were more likely to report SAEs compared to those taking placebo. Results were imprecise and CIs encompassed no difference (RR 1.16, 95% CI 0.90 to 1.48; I2 = 0%; 21 studies, 10,625 participants; moderate-certainty evidence, downgraded one level due to imprecision). We found high-certainty evidence that use of bupropion resulted in more trial dropouts due to adverse events of the drug than placebo (RR 1.37, 95% CI 1.21 to 1.56; I2 = 19%; 25 studies, 12,340 participants). Participants randomized to bupropion were also more likely to report psychiatric AEs compared with those randomized to placebo (RR 1.25, 95% CI 1.15 to 1.37; I2 = 15%; 6 studies, 4439 participants). We also looked at the safety and efficacy of bupropion when combined with other non-antidepressant smoking cessation therapies. There was insufficient evidence to establish whether combination bupropion and nicotine replacement therapy (NRT) resulted in superior quit rates to NRT alone (RR 1.19, 95% CI 0.94 to 1.51; I2 = 52%; 12 studies, 3487 participants), or whether combination bupropion and varenicline resulted in superior quit rates to varenicline alone (RR 1.21, 95% CI 0.95 to 1.55; I2 = 15%; 3 studies, 1057 participants). We judged the certainty of evidence to be low and moderate, respectively; in both cases due to imprecision, and also due to inconsistency in the former. Safety data were sparse for these comparisons, making it difficult to draw clear conclusions. A meta-analysis of six studies provided evidence that bupropion resulted in inferior smoking cessation rates to varenicline (RR 0.71, 95% CI 0.64 to 0.79; I2 = 0%; 6 studies, 6286 participants), whilst there was no evidence of a difference in efficacy between bupropion and NRT (RR 0.99, 95% CI 0.91 to 1.09; I2 = 18%; 10 studies, 8230 participants). We also found some evidence that nortriptyline aided smoking cessation when compared with placebo (RR 2.03, 95% CI 1.48 to 2.78; I2 = 16%; 6 studies, 975 participants), whilst there was insufficient evidence to determine whether bupropion or nortriptyline were more effective when compared with one another (RR 1.30 (favouring bupropion), 95% CI 0.93 to 1.82; I2 = 0%; 3 studies, 417 participants). There was no evidence that any of the other antidepressants tested (including St John's Wort, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs)) had a beneficial effect on smoking cessation. Findings were sparse and inconsistent as to whether antidepressants, primarily bupropion and nortriptyline, had a particular benefit for people with current or previous depression. AUTHORS' CONCLUSIONS: There is high-certainty evidence that bupropion can aid long-term smoking cessation. However, bupropion also increases the number of adverse events, including psychiatric AEs, and there is high-certainty evidence that people taking bupropion are more likely to discontinue treatment compared with placebo. However, there is no clear evidence to suggest whether people taking bupropion experience more or fewer SAEs than those taking placebo (moderate certainty). Nortriptyline also appears to have a beneficial effect on smoking quit rates relative to placebo. Evidence suggests that bupropion may be as successful as NRT and nortriptyline in helping people to quit smoking, but that it is less effective than varenicline. There is insufficient evidence to determine whether the other antidepressants tested, such as SSRIs, aid smoking cessation, and when looking at safety and tolerance outcomes, in most cases, paucity of data made it difficult to draw conclusions. Due to the high-certainty evidence, further studies investigating the efficacy of bupropion versus placebo are unlikely to change our interpretation of the effect, providing no clear justification for pursuing bupropion for smoking cessation over front-line smoking cessation aids already available. However, it is important that where studies of antidepressants for smoking cessation are carried out they measure and report safety and tolerability clearly.


Asunto(s)
Ansiolíticos/uso terapéutico , Antidepresivos/uso terapéutico , Cese del Hábito de Fumar/métodos , Fumar/tratamiento farmacológico , Ansiolíticos/efectos adversos , Antidepresivos/efectos adversos , Bupropión/efectos adversos , Bupropión/uso terapéutico , Humanos , Nortriptilina/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Inhibidores de la Captación de Serotonina/uso terapéutico , Fumar/psicología , Cese del Hábito de Fumar/psicología , Dispositivos para Dejar de Fumar Tabaco , Vareniclina/efectos adversos , Vareniclina/uso terapéutico
14.
J Clin Neurosci ; 78: 236-241, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32334957

RESUMEN

Data regarding the efficacy and safety of smoking-cessation pharmacotherapy after stroke are lacking. We systematically reviewed data on this topic by searching Medline, Cochrane, and Clinicaltrials.gov to identify randomized clinical trials (RCT) and observational studies that assessed the efficacy and safety of nicotine replacement therapy (NRT), varenicline, and bupropion in patients with stroke and TIA. We included studies that reported rates of smoking cessation, worsening or recurrent cerebrovascular disease, seizures, or neuropsychiatric events. We identified 2 RCTs and 6 observational studies; 3 included ischemic stroke and TIA, 2 subarachnoid hemorrhage (SAH), and 3 did not specify. Four studies assessed efficacy; cessation rates ranged from 33% to 66% with pharmacological therapy combined with behavioral interventions versus 15% to 46% without, but no individual study demonstrated a statistically significant benefit. Safety data for varenicline and buopropion in ischemic stroke were scarce. Patients with SAH who received NRT had more seizures (9% vs 2%; P = 0.024) and delirium (19% vs 7%; P = 0.006) in one study, but less frequent vasospasm in 3 studies. In conclusion, combined with behavioral interventions, smoking-cessation therapies resulted in numerically higher cessation rates. Limited safety data may prompt caution regarding seizures and delirium in patients with subarachnoid hemorrhage.


Asunto(s)
Ataque Isquémico Transitorio , Cese del Hábito de Fumar , Fumar/tratamiento farmacológico , Accidente Cerebrovascular , Bupropión/uso terapéutico , Femenino , Humanos , Estudios Observacionales como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Convulsiones/tratamiento farmacológico , Dispositivos para Dejar de Fumar Tabaco , Vareniclina/uso terapéutico
15.
PLoS One ; 15(3): e0230656, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32214373

RESUMEN

INTRODUCTION: Smoking is a strong risk factor for disease severity in Crohn's disease (CD) and cessation improves outcomes. The nicotine metabolite ratio (NMR) predicts cessation success with pharmacotherapy: varenicline doubles cessation over nicotine replacement therapy (NRT) for "normal", but not "slow" metabolizers. Varenicline side effects are heightened in slow metabolizers. Methods using NMR to optimize cessation pharmacotherapy have not been evaluated in CD. AIMS: We aim to determine the prevalence of smoking in a CD population and then assess these smokers' attitudes toward a personalized metabolism-informed care (MIC) approach to cessation. METHODS: In this observational study, we surveyed 1098 patients visiting an inflammatory bowel disease center about their smoking history. We then evaluated a subgroup of individuals with CD (n = 32) who participated in a randomized controlled trial of smoking cessation using MIC versus usual care. For MIC, medication selection was informed by the NMR (normal ≥0.31 vs. slow <0.31). The primary outcomes were intervention satisfaction and match rates between NMR and medication choice. RESULTS: The baseline prevalence of smoking in our CD population was 13%. Intervention participants reported high rates of satisfaction (85%) and chose a medication that matched their NMR result more often in the MIC group (100% vs. 64%, p = 0.01). Six of 16 (37.5%) patients prescribed varenicline discontinued due to side effects. CONCLUSION: MIC produced high rates of satisfaction and matching between NMR and medication in CD patients, supporting patient acceptance and feasibility of precision smoking cessation in this population. To reduce smoking in CD, therapies such as MIC are needed to maximize efficacy and minimize side effects.


Asunto(s)
Enfermedad de Crohn/patología , Nicotina/metabolismo , Cese del Hábito de Fumar/métodos , Adulto , Bupropión/efectos adversos , Bupropión/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Proyectos Piloto , Prevalencia , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Fumar/tratamiento farmacológico , Fumar/epidemiología , Dispositivos para Dejar de Fumar Tabaco/efectos adversos , Resultado del Tratamiento , Vareniclina/efectos adversos , Vareniclina/uso terapéutico
16.
Rev Mal Respir ; 37(3): 267-274, 2020 Mar.
Artículo en Francés | MEDLINE | ID: mdl-32197931

RESUMEN

Lung cancer is the leading cause of cancer related death among people living with HIV (PLHIV). Tobacco exposure is higher among PLHIV (38.5%) and mainly explains the increased risk of lung cancer. To reduce lung cancer mortality, two approaches need to be implemented: lung cancer screening with low-dose thoracic CT scan and smoking cessation. Low dose CT scan is feasible in PLHIV. The false positive rate is not higher than in the general population, except for cases with CD4 <200/mm3. The impact on survival remains to be assessed. Despite the high prevalence, smoking cessation research among PLHIV is scarce. Very low quality data from 11 studies showed that more intensive smoking cessation interventions were effective in achieving short-term abstinence. A single randomized phase 3 trial showed the superiority of varenicline compared to placebo in long-term smoking cessation. The maximum benefit of reducing lung cancer mortality should be obtained by combining smoking cessation and lung cancer screening.


Asunto(s)
Infecciones por VIH/mortalidad , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/terapia , Detección Precoz del Cáncer , VIH/fisiología , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Infecciones por VIH/terapia , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico , Fumar/efectos adversos , Fumar/epidemiología , Fumar/terapia , Cese del Hábito de Fumar , Vareniclina/uso terapéutico
17.
East Mediterr Health J ; 26(1): 110-115, 2020 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-32043553

RESUMEN

The report aimed to review and assess the status of tobacco cessation services in the Eastern Mediterranean Region (EMR). Nearly 70% of people in the Region have legal access to nicotine-replacement therapy but for 77% of these people the costs of the treatment are not covered. Bupropion and Varenicline are legally available in 10 and 11 EMR countries respectively. Just under 50% of people in the Region have access to at least some cessation support in primary health care facilities. Around 32% of people have access to a national toll-free quit line. Costs for cessation services are fully covered in few EMR countries; however, cessation services in the Region must be improved. Member States should aim to increase the availability of, and financial support for, cessation treatments and support, which should be prioritized in primary health care facilities.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Agentes para el Cese del Hábito de Fumar/uso terapéutico , Cese del Hábito de Fumar/métodos , África del Norte , Bupropión/provisión & distribución , Bupropión/uso terapéutico , Humanos , Medio Oriente , Atención Primaria de Salud/estadística & datos numéricos , Agentes para el Cese del Hábito de Fumar/economía , Agentes para el Cese del Hábito de Fumar/provisión & distribución , Vareniclina/provisión & distribución , Vareniclina/uso terapéutico
18.
Expert Opin Pharmacother ; 21(5): 581-590, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32011186

RESUMEN

Introduction: Rates of tobacco smoking are high in people with schizophrenia with greater difficulty of quitting smoking compared to the general population, which also relate to the increased cardiovascular and cancer risks in this co-occurring disorder. Therefore, effective smoking cessation pharmacotherapies addressing tobacco co-morbidity are imperative.Areas covered: In this review, the authors performed an extensive systematic electronic literature review examining the efficacy and safety of first-line pharmacotherapies for smoking cessation, including varenicline, sustained-release bupropion, and nicotine replacement therapies (NRT) using continuous abstinence rates over 10-12-week periods in smokers with schizophrenia. Twelve trials reporting smoking cessation outcomes using interventions in schizophrenia were included and risk ratio (RR) was used.Expert opinion: Our findings support the efficacy and safety of first-line pharmacotherapies for the treatment of tobacco use disorder in smokers with schizophrenia. Further research on the long-term effectiveness and safety of these agents in community samples is warranted. Smoking cessation pharmacotherapies may warrant the consideration of the emerging use of electronic nicotine delivery systems while neuromodulation techniques also offer promise.


Asunto(s)
Esquizofrenia/tratamiento farmacológico , Cese del Hábito de Fumar/métodos , Fumar/tratamiento farmacológico , Benzazepinas/uso terapéutico , Bupropión/uso terapéutico , Humanos , Agonistas Nicotínicos/uso terapéutico , Quinoxalinas/uso terapéutico , Fumar/psicología , Dispositivos para Dejar de Fumar Tabaco , Vareniclina/uso terapéutico
19.
Psychopharmacology (Berl) ; 237(4): 1223-1231, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31938877

RESUMEN

RATIONALE: Barriers to smoking cessation, including negative affect and cognitive dysfunction, may contribute to high smoking rates among people living with HIV/AIDS (PLWH). Varenicline may help PLWH quit smoking by improving mood and cognition, yet this has not been explored. OBJECTIVES: The goal of this study was to evaluate the effect of varenicline on mood and cognition among PLWH enrolled in a smoking cessation clinical trial. METHODS: In this secondary analysis of a varenicline trial (NCT01710137), we assessed mood (depression, anxiety) and cognition (attention, working memory) at weeks 0 (baseline), 1, 3, and 12 (end-of-treatment, EOT). Primary outcomes were changes in mood and cognition from baseline to EOT. Secondarily, mood and cognition were evaluated as predictors of biochemically confirmed 7-day point-prevalence abstinence at EOT. RESULTS: Overall, 173 subjects (87 varenicline, 86 placebo) were included. At EOT, varenicline reduced anxiety (P < 0.001), vs. placebo (P = 0.31; interaction P = 0.05). Across both treatment arms, reductions in anxiety from baseline to EOT were associated with a higher likelihood of abstinence (OR = 1.3, 95% CI 1.1 to 1.6, P = 0.01). There were no significant treatment by time interactions for cognition or depression. CONCLUSIONS: These data suggest that varenicline operates, at least in part, by reducing anxiety. Anxiety should be an intervention target for smokers with HIV interested in quitting.


Asunto(s)
Afecto/efectos de los fármacos , Fumar Cigarrillos/psicología , Cognición/efectos de los fármacos , Infecciones por VIH/psicología , Fumadores/psicología , Vareniclina/uso terapéutico , Adulto , Afecto/fisiología , Ansiedad/tratamiento farmacológico , Ansiedad/epidemiología , Ansiedad/psicología , Fumar Cigarrillos/tratamiento farmacológico , Fumar Cigarrillos/epidemiología , Cognición/fisiología , Femenino , Estudios de Seguimiento , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/psicología , Agentes para el Cese del Hábito de Fumar/farmacología , Agentes para el Cese del Hábito de Fumar/uso terapéutico , Vareniclina/farmacología , Adulto Joven
20.
Psychopharmacology (Berl) ; 237(1): 11-19, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31792645

RESUMEN

BACKGROUND: People with schizophrenia frequently have cognitive dysfunction, which does not respond to pharmacological interventions. Varenicline has been identified as a potential treatment option for nicotinic receptor dysfunction with a potential to treat cognitive impairment in schizophrenia. METHODS: We conducted a systematic review of Pubmed, Embase, Psycinfo, CINAHL and the Cochrane Schizophrenia Trial Registry for randomised controlled trials of varenicline in people with schizophrenia for cognitive dysfunction. We excluded trials among people with dementia. We then undertook a meta-analysis with the primary outcome of difference in change of cognitive measures between varenicline and placebo as well as secondary outcomes of difference in rates of adverse events. We conducted a sensitivity analysis on smoking status and study duration. RESULTS: We included four papers in the meta-analysis (n = 339). Varenicline was not superior to placebo for overall cognition (SMD = -0.022, 95% CI -0.154-0.110; Z = -0.333; p = 0.739), attention (SMD = -0.047, 95% CI -0.199-0.104; Z = -0.613; p = 0.540), executive function (SMD = -0.060, 95% CI -0.469-0.348; Z =- 0.290; p = 0.772) or processing speed (SMD = 0.038, 95% CI -0.232-0.308; Z = 0.279; p = 0.780). There was no difference in psychotic symptoms, but varenicline was associated with higher rates of nausea. Sensitivity analyses for smoking status and study duration did not alter the results. CONCLUSION: Within the present literature, varenicline does not appear to be a useful target compound for improving cognitive impairment in schizophrenia. Based on these results, a trial would need over 2500 participants to be powered to show statistically significant findings.


Asunto(s)
Disfunción Cognitiva/tratamiento farmacológico , Agonistas Nicotínicos/uso terapéutico , Esquizofrenia/complicaciones , Vareniclina/uso terapéutico , Humanos , Esquizofrenia/tratamiento farmacológico
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...