University of Vermont, Dept. of Psychiatry, Burlington, Vermont 05401, USA.
Addict Behav. 2011 Dec;36(12):1288-91. doi: 10.1016/j.addbeh.2011.08.001. Epub 2011 Aug 5.
Most treatment guidelines recommend that smokers should set a target quit date (TQD) at treatment onset because making a public commitment to quit on a given date should increase motivation. On the other hand, allowing smokers the flexibility to choose when to stop after starting treatment might allow smokers to better tailor their quit date and might improve the acceptability of treatment among smokers not willing to set a TQD. In a recent placebo-controlled study, we found varenicline effective when smokers were not required to set a quit date a priori; i.e., with a "flexible quit date" (FQD) approach. The current analysis compares the effect sizes and quit rates in this FQD study with those of nine prior varenicline randomized controlled trials (RCTs) that used a TQD approach. The odds ratio for varenicline versus placebo in the FQD study was the 4th highest of the 10 trials and the incidence of continuous abstinence for varenicline was 5th highest. These results suggest that a FQD approach can produce quit rates similar to a TQD approach. Cross-study comparisons can have hidden bias; thus, a RCT of fixed versus flexible quit dates would provide a more valid test. Also, a study of whether different subpopulations of smokers may be more interested in or especially benefit from, one or the other approach to quitting is indicated.
大多数治疗指南建议吸烟者在开始治疗时设定一个目标戒烟日期（TQD），因为在特定日期公开承诺戒烟应该会增加动机。另一方面，允许吸烟者在开始治疗后灵活选择停止吸烟的时间，可能会让吸烟者更好地调整他们的戒烟日期，并可能提高不愿意设定 TQD 的吸烟者对治疗的接受度。在最近的一项安慰剂对照研究中，我们发现当吸烟者不需要事先设定戒烟日期时，伐尼克兰是有效的；即采用“灵活戒烟日期”（FQD）方法。本分析比较了 FQD 研究与使用 TQD 方法的九项先前伐尼克兰随机对照试验（RCT）的效果大小和戒烟率。FQD 研究中伐尼克兰与安慰剂相比的优势比是这 10 项试验中的第 4 高，伐尼克兰的持续戒烟率是第 5 高。这些结果表明，FQD 方法可以产生类似于 TQD 方法的戒烟率。跨研究比较可能存在潜在偏见；因此，固定与灵活戒烟日期的 RCT 将提供更有效的检验。此外，还需要研究不同的吸烟人群是否对一种或另一种戒烟方法更感兴趣或特别受益。
