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Association between Nicotine Metabolite Ratio and Smoking Cessation Medications in Chinese Male Smokers - Results of the China National Tobacco Cessation Cohort Study
27 Pages Posted: 16 Nov 2023
More...Abstract
Background: Nicotine metabolic ratio (NMR) is correlated with nicotine metabolism and smoking-related characteristics. However, as the world’s largest tobacco consumer, few studies have assessed the association between NMR and smoking cessation efficacy in the Chinese population.
Methods: Data came from 1,333 male smokers attending the China National Tobacco Cessation Cohort (CNTCC) Study from December 2017 to June 2022, which was a multi-center prospective cohort study in China. Participants received medication treatment (varenicline, bupropion or nicotine gum), and NMR was measured in those who had blood samples at baseline. Lower metabolizers were defined as those with NMR≤0.24, and higher metabolizers as those with NMR＞0.24. The primary outcome was the 24-week sustained abstinence rate.
Findings: Of all participants, the 24-week sustained abstinence rate was significantly higher in lower metabolizers (32.2%) than in higher metabolizers (20.1%) (OR=1.96, 95%CI 1.52-2.53, P＜0.05). For higher metabolizers, the 24-week sustained abstinence rate was significantly higher in the varenicline group (29.0%) than in the bupropion group (16.4%) and nicotine gum group (15.0%) (OR=2.16, 95%CI 1.38-3.36, P<0.05; OR=2.39, 95%CI 1.29-4.41, P<0.05), and there was no significant difference in the comparison of bupropion and nicotine gum (OR=1.11,95%CI 0.61-2.01, P＞0.05). For lower metabolizers, the 9-12w and 24-week sustained abstinence rates were similar among the three groups.
Interpretation: Our findings showed that varenicline was superior to bupropion and nicotine gum for higher metabolizers of nicotine, but had equivalent efficacy for lower metabolizers in Chinese male smokers. NMR promises to be a biomarker for personalized smoking cessation treatment for Chinese male smokers.
Trial Registration: Registered in the Chinese Clinical Trial Registry (No.: ChiCTR1800016919, URL: http://www.chictr.org.cn).
Funding: National High Level Hospital Clinical Research Funding of China (2022-NHLHCRF-LX-01-0102); Science and Technology Project of Heilongjiang Province of China (2022ZXJ03C02).
Declaration of Interest: All authors have completed the ICMJE uniform disclosure form, and all the authors declared no conflicts of interest; no financial relationships with any organizations that might have an interest in the submitted work; no other relationships or activities that could appear to have influenced the submitted work.
Ethical Approval: The CNTCC study was approved by the Institutional Review Boards of China- Japan Friendship hospital (No. 2017-125) and by other participating hospitals. All participants signed informed consent forms.
Keywords: smoking cessation, nicotine metabolic ratio, China, cohort study
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