Quit Smoking Fast With Treatment Clearing Nicotine Metabolism Disparities

A new study analyses Whether treatment support can optimize nicotine replacement therapy to quit smoking faster, using biomarker nicotine metabolite ratio.

Enhanced treatment support can help smokers who find nicotine replacement therapy very difficult to quit the habit. This happens because those people were fast metabolizers of nicotine, according to the study published in Nicotine & Tobacco Research.

This is the latest finding from the Vanderbilt Center for Tobacco, Addiction, and Lifestyle (ViTAL) that supports a personalized medicine approach to smoking cessation.

Effects of Nicotine Metabolic Rate on Response to Cigarette Smoking Abstinence

Researchers previously determined that fast metabolizers benefit more from varenicline — a medication that mimics the pleasant effects of nicotine on the brain — than nicotine replacement therapy, such as the patch and gum ().

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‘‘Treatment support increased smoking abstinence and optimal use of a nicotine replacement therapy, by mitigating the gap between fast and slow metabolizers. #NotobaccoDay #Smoking #smoking cessation’’

Despite this evidence, however, many smokers don’t use varenicline because of its cost and lingering negative perceptions, so the researchers studied if nicotine replacement therapy could be delivered in a way that made it more effective for fast metabolizers.

The investigators found that providing fast metabolizers with enhanced treatment support doubled their odds of quitting and narrowed the abstinence disparity with slow metabolizers.

Fast nicotine metabolizers are genetically predisposed to smoke more and have more trouble quitting. One would therefore think they would benefit from more intensive support for their quit attempts, but this hadn’t been studied.

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They tested 321 smokers hospitalized at VUMC for the nicotine metabolite ratio, a validated biomarker that distinguishes fast nicotine metabolizers from slow metabolizers based on the ratio of two nicotine breakdown products, cotinine, and 3-hydroxycotinine, in their blood.

Fast metabolizers numbered 241, while slow metabolizers numbered 80. At hospital discharge, each group was randomized on a 50/50 basis to receive one of two smoking cessation interventions centered around nicotine replacement therapy: usual care or enhanced treatment support.

Do Enhanced Treatment Helps Quit Smoking Faster?

Participants assigned to usual care were referred to the state quit line, which called participants after discharge to offer cessation counseling and a choice of free nicotine patches or lozenges by mail.

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In contrast, the enhanced intervention provided both patches and lozenges in hand at discharge, as well as access to a VUMC-affiliated tobacco treatment counselor who could coach participants on the optimal use of nicotine replacement therapy and other aspects of quitting.

The results showed that providing enhanced treatment support to fast metabolizers narrowed the disparity in quit rates with slow metabolizers. In the usual care arm, 25% of slow metabolizers and 10% of fast metabolizers quit smoking 6 months after hospital discharge.

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Enhanced treatment support increased the latter proportion to 17%, thus cutting in half the abstinence gap between fast and slow metabolizers (). However, given that this was a subgroup analysis of a larger trial, they cautioned that the results should be considered exploratory until they are validated in a dedicated study.

Treating smoking is poised to shift from a one-size-fits-all approach to one that’s tailored to each person’s genetics and other individual factors. This study suggests that coaching fast metabolizers on the proper use of nicotine replacement therapy may offset the negative impact of fast nicotine metabolism on quitting ().

Simple reminders from a health coach, such as combining a daily nicotine patch with short-acting lozenge use throughout the day, can make all the difference for successful quitting.

References:

Rate of Nicotine Metabolism and Smoking Cessation Outcomes in a Community-based Sample of Treatment-Seeking Smokers - (https://www.sciencedirect.com/science/article/abs/pii/S0306460315002750)
Can treatment support mitigate nicotine metabolism-based disparities in smoking abstinence? Secondary analysis of the Helping HAND 4 trial - (https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntad079/7174968)
Precision nicotine metabolism-informed care for smoking cessation in Crohn’s disease: A pilot study - (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230656)

Source-Eurekalert