Metabolism-informed care — a treatment strategy that matches normal metabolizers with a non-nicotine-based therapy such as Chantix and slow nicotine metabolizers with nicotine replacement therapy patch — was an acceptable option for patients who wanted to stop smoking, according to findings published in Nicotine & Tobacco Research.
“[Previous study] findings provide a rationale for metabolism-informed care,” Quinn Wells, PharmD, MD, assistant professor of medicine at Vanderbilt University Medical Center, and colleagues wrote. “By thus increasing the match rates between [nicotine metabolite ratios] and pharmacotherapy, [metabolism-informed care] could maximize the efficacy for normal metabolizers while minimizing side effects for slow metabolizers.”
Researchers asked 81 outpatient adult daily smokers (median age, 53 years) with medical comorbidity about their perceptions of metabolism-informed care, collected blood samples to ascertain nicotine metabolite ratio and provided expert cessation counseling. Medication selection was determined in the treatment group by patients’ nicotine metabolite ratio results — normal ( 0.31) vs. slow (< 0.31).
The primary outcome was metabolism-informed care feasibility, indicated by the attitudes toward it and by match rates between nicotine metabolite ratio and medication. Secondary endpoints were smoking status, medication use and cessation confidence, which were assessed over 6 months to inform future studies.
Wells and colleagues found that about 90% of the participants endorsed metabolism-informed care. Despite Chantix (varenicline, Pfizer) prescription rates of about 60% in both cohorts, nicotine metabolite ratio medication matching was higher in metabolism-informed care (84%) compared with guidelines-based care (58%; unadjusted OR = 3.67; 95% CI, 1.33-11). Secondary endpoints were nearly identical at 1, 3 and 6 months.
“To our knowledge, this is the first study to demonstrate feasibility of a [nicotine metabolite ratio]-based approach to smoking cessation in a clinical setting,” Quinn and colleagues wrote. “These results, in combination with the recent study demonstrating greater efficacy of varenicline among normal metabolizers, have potentially broad implications for tobacco treatment.”
Researchers suggested that future trials examine the implementation and effectiveness of metabolism-informed care for clinical populations. – by Janel Miller
Quinn reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.