NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK.
Gloucestershire Retinal Research Group, Cheltenham General Hospital, Cheltenham, UK.
Addiction. 2018 Feb;113(2):313-324. doi: 10.1111/add.14004. Epub 2017 Oct 1.
To assess how far the greater effectiveness of varenicline over nicotine replacement therapy (NRT) is moderated by characteristics of the smokers or setting in clinical practice.
We used observational data from 22 472 treatment episodes between 2013 and 2016 from smoking cessation services in England to assess whether differences between varenicline and NRT were moderated by a set of smoker and setting characteristics: these included level of social deprivation, age, gender, ethnic group, nicotine dependence and treatment context. From the above, 15 640 episodes were analysed in relation to 4-week quit and 14 273 episodes at 12 weeks. All two-way interactions involving pharmacotherapy were fitted in addition to the main effects and a parsimonious model identified using a backwards stepwise selection procedure.
England PARTICIPANTS: Clients of smoking cessation service (number of individuals in 4-week quit analysis = 15 640).
Four-week carbon monoxide-validated (primary outcome) and 12-week self-reported (secondary outcome) quit success/failure.
At both follow-up points, varenicline was associated with higher success rates overall [P < 0.001 at both 4 and 12 weeks; adjusted odds ratio (OR) varenicline versus NRT = 1.82 (95% confidence interval (CI) = 1.61, 2.06) and 2.58 (95% CI = 2.26, 2.94) at 4 and 12 weeks, respectively]. At 12 weeks, the relative benefits of varenicline were found to be influenced by the setting in which advice was provided [P < 0.001 for interaction pharmacotherapy × setting; adjusted odds ratio for varenicline × pharmacy setting = 0.53 (95% CI = 0.42, 0.69) and for varenicline × general practice (GP) setting = 0.79 (95% CI = 0.64, 0.98) against a baseline of 1 for varenicline × community setting]. The same trends were evident at 4 weeks, but this did not translate to statistical significance. There was inconclusive evidence for moderating effects of other variables.
Varenicline use was associated with higher smoking cessation rates than nicotine replacement therapy in routine clinical practice, irrespective of a wide range of smoker characteristics, but the difference was less in certain intervention settings, most notably pharmacy but also GP practice, compared with community setting.
评估在临床实践中，吸烟者或环境特征对伐尼克兰相对于尼古丁替代疗法（NRT）更有效程度的影响。
我们使用了 2013 年至 2016 年期间英格兰戒烟服务中 22472 个治疗阶段的观察性数据，评估了一套吸烟者和环境特征是否调节了伐尼克兰与 NRT 之间的差异：这些特征包括社会剥夺程度、年龄、性别、种族、尼古丁依赖和治疗环境。其中，15640 个阶段与 4 周戒烟和 14273 个阶段与 12 周戒烟有关。除了主要影响外，还拟合了所有涉及药物治疗的双向交互作用，并使用向后逐步选择程序确定了一个简洁的模型。
英格兰
戒烟服务客户（4 周戒烟分析中的个体数量=15640）。
4 周一氧化碳验证（主要结局）和 12 周自我报告（次要结局）戒烟成功/失败。
在两个随访点，伐尼克兰总体上与更高的成功率相关（4 周和 12 周均 P<0.001；伐尼克兰与 NRT 的调整后优势比（OR）分别为 1.82（95%置信区间（CI）为 1.61，2.06）和 2.58（95% CI 为 2.26，2.94））。在 12 周时，发现伐尼克兰的相对益处受提供建议的环境影响（药物治疗×环境交互作用 P<0.001；伐尼克兰×药房环境的调整后 OR 为 0.53（95% CI 为 0.42，0.69）和伐尼克兰×全科医生（GP）环境的调整后 OR 为 0.79（95% CI 为 0.64，0.98），与社区环境的伐尼克兰的基线 1 相比）。4 周时也出现了同样的趋势，但这并没有转化为统计学意义。没有证据表明其他变量有调节作用。
在常规临床实践中，伐尼克兰的使用与尼古丁替代疗法相比，与更高的戒烟率相关，这与广泛的吸烟者特征无关，但在某些干预环境中，差异较小，最显著的是药房，但也包括全科医生实践，与社区环境相比。
