Efficacy of varenicline or bupropion and its association with nicotine metabolite ratio among smokers with COPD

伐尼克兰 安非他酮 医学 尼古丁 慢性阻塞性肺病 代谢物 药理学 戒烟 内科学 病理
作者
Rui Qin,Zhao Liu,Anqi Cheng,Xinmei Zhou,Zheng Su,Ziyang Cui,Jinxuan Li,Xiaowen Wei,Liang Zhao,Kian Fan Chung,Dan Xiao,Chen Wang
出处
期刊:Respirology [Wiley]
卷期号:29 (6): 479-488 被引量:4
标识
DOI:10.1111/resp.14702
摘要

Abstract Background and objective Nicotine metabolic ratio (NMR) has been associated with nicotine metabolism and smoking characteristics. However, there are few studies on the potential association between NMR and smoking cessation efficacy in smokers with chronic obstructive pulmonary disease (COPD) in China or elsewhere. Methods This study was a stratified block randomized controlled trial for smoking cessation in Chinese smokers with COPD. NMR was used as a stratification factor; slow metabolizers were defined as those with NMR <0.31, and normal metabolizers as those with NMR ≥0.31. Participants were randomly assigned to the varenicline or bupropion group. Follow‐up visits were conducted at 1, 2, 4, 6, 9, 12 and 24 weeks. Results Two hundred twenty‐four participants were recruited and analysed from February 2019 to June 2022. In normal metabolizers, the 9–12 weeks continuous abstinence rate of varenicline (43.1%) was higher than in bupropion (23.5%) (OR = 2.47, 95% CI 1.05–5.78, p = 0.038). There was no significant difference in abstinence rates between treatment groups in slow metabolizers (54.1% vs. 45.9%, OR = 1.39, 95% CI 0.68–2.83, p = 0.366). For slow metabolizers, the total score of side effects in the varenicline group was significantly higher than the bupropion group ( p = 0.048), while there was no significant difference in side effects between groups for normal metabolizers ( p = 0.360). Conclusion Varenicline showed better efficacy than bupropion in normal metabolizers, and bupropion showed equivalent efficacy in slow metabolizers with less side effects. According to our study, NMR provides a better justification for both scientific research and tailoring optimal pharmacotherapy for smoking cessation among smokers in COPD.
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