哮喘联盟

   摘要
   与尼古丁替代治疗（NRT）相比，伐尼克兰在老年患者戒烟过程中的有效性尚不明确。本研究前瞻性比较伐尼克兰和NRT在25～54岁吸烟者和≥55岁吸烟者戒烟疗效。
   方法：在13397名参与2012～2015年台湾戒烟项目的受试者中，6336名(19.2%, 年龄≥55岁)受试者接受伐尼克兰治疗，而7061名（23.2%, 年龄≥55岁）受试者接受NRT贴剂或口香糖治疗。6个月后，通过电话随访受试者吸烟行为情况。回归方程预测7天，1个月，6个月时点戒烟率的ORs和95%CI。年龄特异性通过性别，教育，婚姻，吸烟年支，尼古丁依赖程度，医院，就诊次数和用药持续时间等因素调整后进行评价。
   结果：在25～54岁吸烟者中，使用伐尼克兰戒烟者时点戒烟率高于NRT戒烟者（例如，7天时点戒烟率：34.0% vs 23.5%），调整后OR从1.23（CI:1.09-1.39;6个月）至1.37（CI:1.24-1.50;1个月）。在≥55岁吸烟者中，两者疗效相似（例如，7天时点戒烟率：32.3% vs 33.1%），而ORs未提示两者存在疗效差异。与NRT相比，性别和尼古丁依赖程度并不改变伐尼克兰年龄特异性疗效。
   结论：对于在≥55岁吸烟者，在戒断率方面，伐尼克兰疗效并非优于NRT，而在25～54岁吸烟这种疗效更为突出。本研究结果提示有效的控烟策略需注重年龄相关因素。
   临床应用：在本项前瞻性的队列研究中，在6个月随访期，老年吸烟者（≥55岁）接受伐尼克兰治疗与NRT或口香糖治疗相比并无时点戒断率优势。在较年轻（25～54岁）吸烟者中伐尼克兰的疗效更为显著。性别和尼古丁依赖程度并不改变年龄特异性伐尼克兰有效性。有效的戒烟策略有赖于考量年龄的因素。

 

（上海交通大学医学院附属瑞金医院呼吸与危重症医学科 周剑平 万欢英 摘译）
（Nicotine Tob Res. 2017 Dec 23. doi: 10.1093/ntr/ntx275. [Epub ahead of print]）

 
 
Comparative effectiveness of varenicline and nicotine replacement therapy for smoking cessation in older and younger smokers: a prospective cohort in Taiwan.
 
Nicotine Tob Res. 2017 Dec 23. doi: 10.1093/ntr/ntx275. [Epub ahead of print]
Chang PY, Shiu MN, Yuan YT, Chang HC, Su PY, Lan TH.

Abstract
The effectiveness of varenicline compared to nicotine replacement therapy (NRT) in achieving smoking cessation in older smokers has not been investigated. This study prospectively compared the effectiveness of varenicline relative to NRT in smokers age 25-54 and separately in smokers 55 years or older.

METHODS:Among 13,397 smokers participating in the Smoking Cessation Program in Taiwan, 2012-2015, 6,336 (19.2% age ≥55) received varenicline and 7,061 received NRT patch or gum (23.2% age ≥55). Participants self-reported smoking behaviors by phone interview after 6 months. Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for 7-day, 1-month, and 6-month point-prevalence abstinence. Age-specific models adjusted for sex, education, marital status, smoke-years, nicotine dependence, medical institution, clinic visit number and duration of medication received.

RESULTS:Among smokers age 25-54, varenicline users had a greater point-prevalence abstinence than NRT users (e.g., 7-day point-prevalence: 34.0% vs 23.5%), with adjusted OR ranging from 1.23 (CI: 1.09-1.39; 6-month point-prevalence) to 1.37 (CI: 1.24-1.50; 1-month point-prevalence). Among smokers age 55 or older, point-prevalence was similar for varenicline and NRT users (e.g., 7-day point-prevalence: 32.3% vs 33.1%), and ORs did not suggest that varenicline has greater effectiveness than NRT. Sex and level of nicotine dependence did not modify the age-specific effectiveness of varenicline relative to NRT.

CONCLUSIONS:Varenicline did not offer greater effectiveness in achieving abstinence than NRT for smokers 55 or older, whereas it was more effective than NRT in smokers age 25-54. These findings highlighted the need for age-specific approaches for effective tobacco control.

IMPLICATIONS:In this prospective investigation of a national cohort, older smokers (age ≥55) who received varenicline did not have a greater point-prevalence abstinence after 6 months compared with those who used NRT patch or gum. Younger smokers (age 25-54) who received varenicline had a greater likelihood of abstinence than NRT users. Sex and nicotine dependence did not modify the age-specific effectiveness of varenicline relative to NRT patch or gum. Age-appropriate approaches for effective tobacco control are needed.