An update on helping patients to quit smoking Henri-Jean Aubin University Paris-Sud, Paris, France.
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Transcript of An update on helping patients to quit smoking Henri-Jean Aubin University Paris-Sud, Paris, France.
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An update on helping patients to quit smoking
Henri-Jean AubinUniversity Paris-Sud, Paris, France
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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
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Kaplan-Meier curve of time to relapse
Yeomans, et al. 2011. Int J Clin Pract
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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.
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Benowitz, N. L. (2010) N Engl J Med
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Polosa & Benowitz Trends Pharmacol Sci. 2011
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Polosa & Benowitz Trends Pharmacol Sci. 2011
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Polosa & Benowitz Trends Pharmacol Sci. 2011
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Effectiveness of monotherapies
Adapted from Treating Tobacco Use and Dependence. 2008 Update. Clinical Practice Guideline. (Fiore et al., 2008)
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Effectiveness of combination therapies
Adapted from Treating Tobacco Use and Dependence. 2008 Update. Clinical Practice Guideline. (Fiore et al., 2008)
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Curent contreversies
Varenicline safety
Harm reducion
E-cigarettes
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Curent contreversies
Varenicline safety
Harm reducion
E-cigarettes
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Moore TJ, Furberg CD, Glenmullen J, Maltsberger JT, Singh S. Plos one. 2011;6(11):e27016.
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• Mettre image sur presse chantix suicide
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Suicide fumeurs actuels vs jamais fumeurs
Li, et al. J Psychiatr Res. 2012
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Suicide anciens fumeurs vs jamais fumeurs
Li, et al. J Psychiatr Res. 2012
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Suicide Intensité du tabagisme
Li, et al. J Psychiatr Res. 2012
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Bruijnzeel AW. Tobacco addiction and the dysregulation of brain stress systems. Neurosci Biobehav Rev 2012
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Anthenelli et al. Ann Intern Med 2013;159(6):390-400.
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Efficacy
Anthenelli et al. Ann Intern Med 2013;159(6):390-400.
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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.
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MADRS scores mean change from baseline
Anthenelli et al. Ann Intern Med 2013;159(6):390-400.
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HAM-A scores mean change from baseline
Anthenelli et al. Ann Intern Med 2013;159(6):390-400.
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Psychiatric adverse events
Anthenelli et al. Ann Intern Med 2013;159(6):390-400.
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Participants with positive responses at the Columbia Suicide Severity rating Scale
Anthenelli et al. Ann Intern Med 2013;159(6):390-400.
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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.
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Thomas et al. BMJ 2013;347:f5704..
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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
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Thomas et al. BMJ 2013;347:f5704..
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Curent contreversies
Varenicline safety
Harm reducion
E-cigarettes
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Curent contreversies
Varenicline safety
Harm reducion
E-cigarettes
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Low risk drinking
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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
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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
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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
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No low risk smoking
Photos: Colourbox.com
41
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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
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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
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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
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Curent contreversies
Varenicline safety
Harm reducion
E-cigarettes
![Page 46: An update on helping patients to quit smoking Henri-Jean Aubin University Paris-Sud, Paris, France.](https://reader030.fdocuments.in/reader030/viewer/2022032516/56649c7c5503460f94931729/html5/thumbnails/46.jpg)
Curent contreversies
Varenicline safety
Harm reducion
E-cigarettes