安非他酮用于青少年戒烟：依从性的作用。
Adolescent Smoking Cessation With Bupropion: The Role of Adherence.
作者信息
Leischow Scott J, Muramoto Myra L, Matthews Eva, Floden Lysbeth L, Grana Rachel A
机构信息
Department of Research, Mayo Clinic Arizona, Scottsdale, AZ;
Department of Family and Community Medicine, University of Arizona, Tucson, AZ;
出版信息
Nicotine Tob Res. 2016 May;18(5):1202-5. doi: 10.1093/ntr/ntv179. Epub 2015 Nov 13.
INTRODUCTION
While many medications can be effective aids to quitting tobacco, real world adherence to smoking cessation medications may render a potentially effective medication ineffective. The present study investigated the role of adherence on treatment outcomes in a bupropion dose-response study among adolescent smokers trying to quit smoking.
METHODS
Three hundred twelve adolescent boys (n = 143) and girls (n = 169) between the ages of 14-17 were enrolled in the study, and were randomly assigned to use either 300 mg, 150 mg or placebo bupropion to quit smoking. Among the eligibility criterion, participants had to smoke at least six cigarettes per day, be motivated to quit smoking (self report), have an exhaled carbon monoxide level greater than or equal to 10 ppm, and report at least two previous quit attempts. Adherence to medication was determined by both self-report and actual counts of unused medication and empty medication packaging. Smoking status was determined by a combination of self-report and biochemical verification (breath carbon monoxide and urine cotinine).
RESULTS
Cotinine-confirmed quit rates were significantly higher as a function of high adherence (20.69%) relative to low adherence (0.00%) in the 300-mg Bupropion Sustained Release group. Overall adherence in all study conditions in this highly controlled study was high (74%), but was significantly lower in non-white participants.
CONCLUSIONS
Effectiveness of bupropion for adolescent smoking cessation is contingent on achieving high rates of medication adherence, but considerable variations in adherence impacted outcomes.
IMPLICATIONS
Few studies have assessed the safety and efficacy of medications to help adolescent smokers quit, and we conducted one such study assessing bupropion. In this analysis of that original study, we assess the role of adherence in use of medication and quit rates. We found that adherence was related to outcomes, particularly in the 300-mg dose of bupropion.
引言
虽然许多药物对戒烟有效，但在现实世界中，对戒烟药物的依从性可能会使一种潜在有效的药物变得无效。本研究在一项关于试图戒烟的青少年吸烟者的安非他酮剂量反应研究中，调查了依从性对治疗结果的作用。
方法
招募了312名年龄在14至17岁之间的青少年男孩（n = 143）和女孩（n = 169），并随机分配他们使用300毫克、150毫克的安非他酮或安慰剂来戒烟。入选标准包括：参与者每天至少吸6支烟，有戒烟意愿（自我报告），呼出一氧化碳水平大于或等于10 ppm，且报告至少有过两次以前的戒烟尝试。通过自我报告以及未使用药物和空药包装的实际计数来确定药物依从性。吸烟状况通过自我报告和生化验证（呼出气一氧化碳和尿可替宁）相结合来确定。
结果
在300毫克安非他酮缓释组中，与低依从性（0.00%）相比，高依从性的可替宁确认戒烟率显著更高（20.69%）。在这项高度受控的研究中，所有研究条件下的总体依从性都很高（74%），但非白人参与者的依从性显著较低。
结论
安非他酮对青少年戒烟的有效性取决于实现高药物依从率，但依从性的显著差异会影响结果。
启示
很少有研究评估帮助青少年吸烟者戒烟药物的安全性和有效性，我们进行了一项这样的研究来评估安非他酮。在对该原始研究的此次分析中，我们评估了依从性在药物使用和戒烟率中的作用。我们发现依从性与结果相关，特别是在300毫克剂量的安非他酮中。
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