Group Health Research Institute Seattle, WA 98101, USA.
Nicotine Tob Res. 2013 Feb;15(2):518-26. doi: 10.1093/ntr/nts173. Epub 2012 Sep 4.
There is increasing evidence that response to pharmacological treatment for nicotine dependence may be moderated by genetic polymorphisms. However, the feasibility, acceptability, and impact of genetically tailoring treatment in real-world clinical settings are unknown.
We conducted a multiphased, mixed-methods feasibility study with current smokers to develop and evaluate a patient-centered, theoretically grounded personalized medicine treatment protocol. The initial research phase included formative work to develop intervention materials. The second phase included a randomized pilot trial to evaluate the intervention. Trial participants (n = 36) were genotyped for ANKK1 rs1800497 and were randomized to receive genetic feedback (GF) plus standard behavioral counseling (BC) for smoking cessation or BC without GF. All participants received genetically tailored pharmacotherapy (nicotine patch or bupropion).
The intervention was feasible to implement and was acceptable to participants based on satisfaction ratings and objective measures of participation. There was no evidence that the GF resulted in adverse psychological outcomes (e.g., depression, fatalism, reduced perceived control over quitting, differential motivation for quitting) based on quantitative or qualitative outcomes.
Study results suggest that it is feasible to offer treatment within a health care setting that includes genetically tailored pharmacotherapy and doing so had no apparent adverse psychological impacts. Further evaluation of pharmacogenetically tailored smoking cessation interventions appears warranted.
越来越多的证据表明，药物治疗尼古丁依赖的反应可能受到遗传多态性的调节。然而，在真实临床环境中，根据遗传因素定制治疗方案的可行性、可接受性和影响尚不清楚。
我们对当前吸烟者进行了多阶段、混合方法的可行性研究，以开发和评估一种以患者为中心、基于理论的个性化医学治疗方案。初始研究阶段包括制定干预措施的形成性工作。第二阶段包括一项随机试点试验，以评估干预措施。试验参与者（n=36）接受 ANKK1 rs1800497 基因分型，并随机分配接受基因反馈（GF）加标准行为咨询（BC）戒烟或不接受 GF 的 BC。所有参与者都接受了基因定制的药物治疗（尼古丁贴片或安非他酮）。
该干预措施在实施方面是可行的，且根据参与者的满意度评分和参与的客观测量，是可以接受的。根据定量或定性结果，没有证据表明 GF 会导致不良的心理后果（例如，抑郁、宿命论、戒烟时降低感知控制、戒烟动机差异）。
研究结果表明，在医疗保健环境中提供包括基因定制药物治疗在内的治疗是可行的，而且这样做没有明显的不良心理影响。进一步评估基于药物遗传学的戒烟干预措施似乎是合理的。
