An update on helping patients to quit smoking Henri-Jean Aubin University Paris-Sud, Paris, France.

An update on helping patients to quit smoking

Henri-Jean AubinUniversity Paris-Sud, Paris, France

Disclosures

Interest Name of organization

Grant Support ANR

Research Support INSERM, ANR, AP-HP

Honoraria and Consultancy Lundbeck, D&A Pharma, Ethypharm, Merck, Pfizer

Speakers Bureau Lundbeck, D&A Pharma, Pfizer

Scientific Advisory Board Lundbeck, D&A Pharma, Ethypharm, Pfizer

Kaplan-Meier curve of time to relapse

Yeomans, et al. 2011. Int J Clin Pract

Success rates with placebo

Moore RA, Aubin HJ. Do placebo response rates from cessation trials inform on strength of addictions? Int J Environ Res Public Health. Jan 2012;9(1):192-211.

Benowitz, N. L. (2010) N Engl J Med

Polosa & Benowitz Trends Pharmacol Sci. 2011

Polosa & Benowitz Trends Pharmacol Sci. 2011

Polosa & Benowitz Trends Pharmacol Sci. 2011

Effectiveness of monotherapies

Adapted from Treating Tobacco Use and Dependence. 2008 Update. Clinical Practice Guideline. (Fiore et al., 2008)

Effectiveness of combination therapies

Adapted from Treating Tobacco Use and Dependence. 2008 Update. Clinical Practice Guideline. (Fiore et al., 2008)

Curent contreversies

Varenicline safety

Harm reducion

E-cigarettes

Curent contreversies

Varenicline safety

Harm reducion

E-cigarettes

Moore TJ, Furberg CD, Glenmullen J, Maltsberger JT, Singh S. Plos one. 2011;6(11):e27016.

• Mettre image sur presse chantix suicide

Suicide fumeurs actuels vs jamais fumeurs

Li, et al. J Psychiatr Res. 2012

Suicide anciens fumeurs vs jamais fumeurs

Li, et al. J Psychiatr Res. 2012

Suicide Intensité du tabagisme

Li, et al. J Psychiatr Res. 2012

Bruijnzeel AW. Tobacco addiction and the dysregulation of brain stress systems. Neurosci Biobehav Rev 2012

Anthenelli et al. Ann Intern Med 2013;159(6):390-400.

Efficacy

Anthenelli et al. Ann Intern Med 2013;159(6):390-400.

MADRS scores mean change from baseline

Anthenelli et al. Ann Intern Med 2013;159(6):390-400.Anthenelli et al. Ann Intern Med 2013;159(6):390-400.

MADRS scores mean change from baseline

Anthenelli et al. Ann Intern Med 2013;159(6):390-400.

HAM-A scores mean change from baseline

Anthenelli et al. Ann Intern Med 2013;159(6):390-400.

Psychiatric adverse events

Anthenelli et al. Ann Intern Med 2013;159(6):390-400.

Participants with positive responses at the Columbia Suicide Severity rating Scale

Anthenelli et al. Ann Intern Med 2013;159(6):390-400.

Suicidalité

Idées ou comportement suicidaire varenicline placeboVie entière

Nombre de patients évalués, N 256 269

Idées ou comportement suicidaire, n (%) 88 (34,4) 89 (33,1)

Visite initiale

Nombre de patients évalués, N 256 269

Idées ou comportement suicidaire, n (%) 6 (2,3) 1 (0,4)

Phase de traitement

Nombre de patients évalués, N 251 268

Idées ou comportement suicidaire, n (%) 15 (6) 20 (7,5)

Phase de suivi sans traitement

Nombre de patients évalués, N 209 207

Idées ou comportement suicidaire, n (%) 13 (6,6) 12 (5,8)

Anthenelli et al. Ann Intern Med 2013;159(6):390-400.

Thomas et al. BMJ 2013;347:f5704..

Methods

Thomas et al. BMJ 2013;347:f5704..

• Prospective cohort study within the Clinical Practice Research Datalink.Design

• 349 general practices in England.Setting

• 119 546 men and women aged 18 years and over who used a smoking cessation product between 1 September 2006 and 31 October 2011. Participants

• 81 545 users of nicotine replacement products (68.2%)• 6741 bupropion (5.6%)• 31 260 varenicline (26.2%)Treatments

Thomas et al. BMJ 2013;347:f5704..

Curent contreversies

Varenicline safety

Harm reducion

E-cigarettes

Curent contreversies

Varenicline safety

Harm reducion

E-cigarettes

Low risk drinking

Rehm et al. Alcohol Res Health 2003;27(1):39–51

J-shaped relationship between alcohol consumption and coronary heart disease

Rel

ativ

e ris

k

0.6

1.6

1.4

1.2

1.0

0.8

Alcohol (g/day)

20 g/day

0 25 50 75 100

125

150

72 g/day

89 g/day

Correlation between alcohol consumption and mortality

Rehm et al. Addiction 2011;106(Suppl 1):11–19

0 20 40 60 80 100

18

12

4

0

Ris

k o

f d

eath

(%

)

16

8

10

2

14

6

Alcohol consumption (g/day)

Men

Women

39

Correlation between alcohol consumption and mortality

Rehm et al. Addiction 2011;106(Suppl 1):11–19

0 20 40 60 80 100

18

12

4

0

Ris

k o

f d

eath

(%

)

16

8

10

2

14

6

Alcohol consumption (g/day)

Men

Women

40

Difference between 11 & 14 drinks per day has an effect on mortality risk about 10 times as much as the difference between 0 & 3 drinks/day

No low risk smoking

Photos: Colourbox.com

41

Relationship between ischaemic heart disease and tobacco exposure

Smith et al. Toxicol Sci 2000;54(2):462–472

Rel

ativ

e ris

k of

isch

aem

ic

hear

t dis

ease

Cigarettes/‘cigarette equivalents’ per day

3.0

2.5

2.0

1.5

1.0

0.5

0.0-5 0 5 10 15 20 25

1.391.3

1.0

1.78

42

Relationship between lung cancer and cigarettes per day

Lubin et al. Cancer Epidemiol Biomarkers Prev 2006;15:517–52343

0.5

0.4

0.3

0.2

0.1

0.50 10 20 30 40 50 60 70

Cigarettes smoked per day

Exc

ess

odds

rat

io (

OR

) pe

r pa

ck-y

ear

Relationship between lung cancer and duration of exposure

Lubin et al. Cancer Epidemiol Biomarkers Prev 2006;15:517–523

30

25

20

15

10

5

00 10 20 30 40 50 60

N.S. and <20 cigarettes/day30

25

20

15

10

5

0

N.S. and 20–29 cigarettes/day

0 10 20 30 40 50 6030

25

20

15

10

5

00 10 20 30 40 50 60

N.S. and 30–39 cigarettes/day

30

25

20

15

10

5

0

N.S. and 40+ cigarettes/day

0 10 20 30 40 50 60

Odd

s ra

tio

Years of cigarette smokingN.S.=never smoked

Curent contreversies

Varenicline safety

Harm reducion

E-cigarettes

Curent contreversies

Varenicline safety

Harm reducion

E-cigarettes