Wolfson Institute of Preventive Medicine, UK Centre for Tobacco Control Studies, Barts and The London, Queen Mary University of London, London E1 2AD, UK.
Addiction. 2009 Sep;104(9):1597-602. doi: 10.1111/j.1360-0443.2009.02646.x.
While older behavioural and pharmacological approaches to preventing relapse to smoking show little efficacy, a recent randomized trial of an extended course of varenicline reported positive results. In this secondary analysis, trial data were examined to see whether smokers who manage to achieve abstinence only later in the original course of treatment are more likely to benefit from having the course extended.
A total of 1208 patients abstinent for at least the last week of 12 weeks' treatment with varenicline were randomized to 3 months continued varenicline or placebo. Overall, 44% of the 12-week abstainers were abstinent from the target quit date (TQD), while the rest stopped smoking later. We examined the relationship between quit pattern and the varenicline versus placebo difference in continuous abstinence rates at week 52 and contributions of baseline patient characteristics.
With increasing delay in initial quitting, 12-month success rates declined. Participants who had their last cigarette at week 11 of open-label treatment had quit rates at 52 weeks of 5.7% compared with 54.9% in those who last smoked in week 1 [odds ratio (OR) 20.3 (6.3, 65.9); P < 0.0001]. Patients who failed to initiate abstinence in the first week benefited more from extended treatment than patients continuously abstinent from week 1 [OR 1.7 (1.2, 2.4); P = 0.0015 versus OR 1.1 (0.8, 1.5); P = 0.6995, respectively; with the interaction of the quit pattern with treatment effect reaching borderline significance (P = 0.0494)]. No other patient characteristics were related to treatment effect.
Compared with smokers who quit smoking on their TQD, those who have an initial delay in achieving sustained abstinence have increased risk of relapse even several months later, and may be more likely to benefit from extended treatment with varenicline.
虽然较老的行为和药理学方法在预防复吸方面效果甚微，但最近一项关于维拉唑尼延长疗程的随机试验报告了积极的结果。在这项二次分析中，检查了试验数据，以了解在最初疗程中仅较晚达到戒烟的吸烟者是否更有可能从延长疗程中受益。
共有 1208 名接受维拉唑尼治疗 12 周后至少最后一周保持戒烟的患者被随机分为继续服用 3 个月维拉唑尼或安慰剂。总体而言，12 周戒烟者中有 44%在目标戒烟日（TQD）时保持戒烟，而其余患者则在之后停止吸烟。我们检查了戒烟模式与维拉唑尼与安慰剂在 52 周连续戒烟率方面的差异之间的关系，以及基线患者特征的贡献。
随着初始戒烟时间的延迟，12 个月的成功率下降。在开放性治疗的第 11 周最后一支烟的参与者在第 52 周的戒烟率为 5.7%，而在第 1 周最后一支烟的参与者为 54.9%（比值比[OR]20.3[6.3，65.9]；P<0.0001）。在第一周未能开始戒烟的患者从延长治疗中获益更多，而不是从第一周持续戒烟的患者[OR 1.7（1.2，2.4）；P=0.0015 与 OR 1.1（0.8，1.5）；P=0.6995，交互作用达到边缘显著（P=0.0494）]。其他患者特征与治疗效果无关。
与在 TQD 时戒烟的吸烟者相比，那些最初延迟达到持续戒烟的吸烟者即使在几个月后也有更高的复发风险，并且可能更有可能从维拉唑尼的延长治疗中受益。
