Department of Behavioural Science and Health, University College London, London, UK.
UK Centre for Tobacco and Alcohol Studies, Nottingham, UK.
Sci Rep. 2017 Dec 14;7(1):17613. doi: 10.1038/s41598-017-17994-8.
Pharmacotherapy provision based on Nicotine Metabolite Ratio (NMR) status (slow/normal metabolism) may improve smoking cessation rates. However, it is unclear whether NMR status is consistent across patient characteristics and current treatment choice. Data come from 1,826 participants attending Stop Smoking Services (SSS) across England in 2012/13. Sociodemographic, mental/physical health, smoking and treatment characteristics (nicotine replacement therapy vs. other pharmacotherapy; group vs. one-to-one behavioural support) were assessed. Salivary nicotine metabolites were measured and NMR (3-hydroxycotinine/cotinine) computed, characterising smokers as slow (NMR < 0.31) or normal (NMR ≥ 0.31) metabolisers. Normal metabolisers were older than slow metabolisers (Odds Ratio (OR) = 1.49, 95% Confidence Interval (CI) = 1.32-1.69) but no other characteristics were associated with NMR status. Overall, predictors accounted for only 7.3% of NMR variance. In adjusted analysis, pharmacotherapy type was not associated with NMR status, but normal metabolisers were less likely to use group support (OR = 0.67, 95% CI = 0.51-0.89). NMR status does not vary substantially across sociodemographic characteristics. Given its impact on pharmacotherapy efficacy, the lack of an association with pharmacotherapy choice suggests there is scope to use NMR status to optimise the selection and efficacy of smoking cessation pharmacotherapy. The unexpected association of NMR status with behavioural support should be explored further.
基于尼古丁代谢物比值（NMR）状态（代谢缓慢/正常）的药物治疗方案可能会提高戒烟率。然而，目前尚不清楚 NMR 状态是否与患者特征和当前治疗选择一致。数据来自于 2012/13 年英格兰戒烟服务中心（SSS）的 1826 名参与者。评估了社会人口统计学、心理健康/身体健康、吸烟和治疗特征（尼古丁替代疗法与其他药物治疗；团体支持与一对一行为支持）。测量了唾液中的尼古丁代谢物，并计算了 NMR（3-羟基可替宁/可替宁），将吸烟者分为代谢缓慢（NMR<0.31）或代谢正常（NMR≥0.31）。正常代谢者比代谢缓慢者年龄大（优势比（OR）=1.49，95%置信区间（CI）=1.32-1.69），但其他特征与 NMR 状态无关。总体而言，预测因素仅解释了 7.3%的 NMR 变异。在调整分析中，药物治疗类型与 NMR 状态无关，但正常代谢者不太可能使用团体支持（OR=0.67，95%CI=0.51-0.89）。NMR 状态在社会人口统计学特征上没有显著差异。鉴于其对药物治疗效果的影响，药物治疗选择与 NMR 状态之间缺乏关联表明，有必要利用 NMR 状态来优化戒烟药物治疗的选择和效果。NMR 状态与行为支持之间意外的关联需要进一步探讨。
