伐尼克兰加戒烟咨询可提高戒断率

旧金山——澳大利亚伊丽莎白女王医院的Brian Smith博士在美国胸科学会(ATS)年会上报告，在196例接受12周伐尼克兰治疗和戒烟咨询的患者中，近1/3(61例)1年内未复吸，而在196例仅接受戒烟咨询的患者中，仅有21%(42例)成功戒烟。

Brian Smith博士

上述结果受到关注的原因还在于，该研究招募的是正在服用抗抑郁药物或有抑郁症病史的患者，而以往针对伐尼克兰(畅沛)的多项研究均将这类患者排除在外。本项研究的受试者入组前均已因心脏、呼吸、神经或血管方面的吸烟相关并发症住院至少1天。与多数医院在患者离开时交给其一张戒烟热线卡的做法不同的是，Smith博士及其同事在患者住院期间就为其提供了首次戒烟咨询服务。Smith博士说：“患者回家后仅有约6%会按照戒烟热线卡上的信息打电话咨询，因此我们决定在患者住院时就拨打他们的床头电话，这样他们就很难推脱了。”

电话另一头的研究者会亲切友好地向患者强调戒烟的益处和继续吸烟的危害，患者如果有戒烟的意愿就可以预约进一步的电话咨询，从而继续接受研究者的帮助。两组患者均接受了标准5A(询问、建议、评估、协助和安排)咨询服务。伐尼克兰+咨询组患者平均每周接受了3.8次电话咨询，而单纯咨询组平均为4.1次。伐尼克兰的剂量从0.5 mg/d滴定至1 mg、2次/d，主要取决于恶心程度。

不良反应方面，伐尼克兰+咨询组患者更多报告失眠(5.1% vs. 2.0%)、头痛(6.1% vs. 1.5%)、呕吐(4.1% vs. 0.5%)和多梦/噩梦(6.1% vs. 1.0%)等问题。尽管目前对伐尼克兰的心血管和精神安全性存有疑虑，但该研究中未观察到服用该药者的心血管或精神风险增加。

Smith博士报告称无相关利益冲突，并且声称畅沛的生产商辉瑞未资助和参与这项试验。参与该试验的患者自己承担了部分药费。

爱思唯尔  版权所有

By: M. ALEXANDER OTTO, Cardiology News Digital Network

SAN FRANCISCO – Almost a third of 196 patients (61) were smoke free a year after starting 12 weeks of varenicline therapy and having smoking-cessation counseling in a randomized Australian trial. Only 21% (42) of 196 patients given counseling alone stopped smoking.

The varenicline-plus-counseling results are impressive because the study included people who were on antidepressants and those with depression histories, both of whom had been excluded from several earlier studies of varenicline (Chantix), said lead investigator Dr. Brian Smith of the respiratory medicine unit at the Queen Elizabeth Hospital in Woodville, Australia.
 
But the most important take-home message of the study was its setup, he said at an international conference of the American Thoracic Society.

The participants had all been hospitalized for at least 1 day for cardiac, respiratory, neurologic, or vascular smoking-related complications. Instead of handing them a quit-smoking hotline card as they walked out the door – the general practice in many hospitals – the investigators had them make their initial counseling service call from the bedside table while they were still in the hospital, Dr. Smith said.

"Only about 6% of patients will make that call" from home. "[We took] the opportunity while they were still inpatients – a captive audience, if you like – to use the bedside phone to make the call. Instead of a 6% success rate, [we had a] 100% success rate," he said.

Patients found a friendly counselor on the other end of the line who emphasized the benefits of quitting instead of the dangers of continuing to smoke. Patients could arrange calls for days when they knew they would be particularly stressed. Counselors would call then to "pull them through," Dr. Smith said.

Both groups got the same standard 5A counseling (ask, advise, assess, assist, and arrange). Patients had the option, if they desired, of several calls a week, but that option wasn’t popular. The mean number of phone calls in the varenicline-plus-counseling arm was 3.8, and in the counseling-only arm it was 4.1.

Varenicline was titrated from 0.5 mg daily to 1 mg twice daily, based largely on nausea. Overall, varenicline patients reported more problems with insomnia (5.1% vs. 2.0% in the counseling-alone group), headache (6.1% vs. 1.5%), vomiting (4.1% vs. 0.5%), and abnormal dreams (6.1% vs. 1.0%).

Despite concerns about the drug, the investigators found no evidence of increased cardiovascular or psychiatric problems in the varenicline group.

"The novel thing of our study is [that we] grabbed the opportunity while these patients were in hospital to get them to make the phone call that otherwise [they] would have been reluctant to make. [We got] them over that hump, got the medication going, [and made] sure they were tolerating it well," Dr. Smith said.

Dr. Smith said he had no disclosures. Pfizer, the maker of Chantix, did not fund and was not involved in the trial, he said. Patients covered at least part of the cost of the drug themselves.