An update on helping patients to quit smoking Henri-Jean Aubin University Paris-Sud, Paris, France
Dec 14, 2015
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