在台湾，对老年和年轻吸烟者而言，伐伦克林与尼古丁替代疗法戒烟的效果比较：一项前瞻性队列研究。
Comparative Effectiveness of Varenicline and Nicotine Replacement Therapy for Smoking Cessation in Older and Younger Smokers: A Prospective Cohort in Taiwan.
机构信息
Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, USA.
Faculty of Pharmacy, National Yang-Ming University, Taipei, Taiwan.
出版信息
Nicotine Tob Res. 2019 Jan 4;21(2):149-155. doi: 10.1093/ntr/ntx275.
INTRODUCTION
The effectiveness of varenicline compared with nicotine replacement therapy (NRT) in achieving smoking cessation in older smokers has not been investigated. This study prospectively compared the effectiveness of varenicline relative to NRT in smokers aged 25-54 years and separately in smokers aged 55 years or older.
METHODS
Among 13 397 smokers participating in the Smoking Cessation Program in Taiwan, 2012-2015, 6336 (19.2%, aged ≥55) received varenicline and 7061 received NRT patch or gum (23.2%, aged ≥55). Participants self-reported smoking behaviors by phone interview after 6 months. Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for 7-day, 1-month, and 6-month point-prevalence abstinence. Age-specific models adjusted for sex, education, marital status, smoke-years, nicotine dependence, medical institution, clinic visit number, and duration of medication received.
RESULTS
Among smokers aged 25-54 years, varenicline users had a greater point-prevalence abstinence than NRT users (e.g., 7-day point-prevalence: 34.0% vs. 23.5%), with adjusted OR ranging from 1.23 (CI: 1.09-1.39; 6-month point-prevalence) to 1.37 (CI: 1.24-1.50; 1-month point-prevalence). Among smokers aged 55 years or older, point-prevalence was similar for varenicline and NRT users (e.g., 7-day point-prevalence: 32.3% vs. 33.1%), and ORs did not suggest that varenicline has greater effectiveness than NRT. Sex and level of nicotine dependence did not modify the age-specific effectiveness of varenicline relative to NRT.
CONCLUSIONS
Varenicline did not offer greater effectiveness in achieving abstinence than NRT for smokers 55 years or older, whereas it was more effective than NRT in smokers aged 25-54 years. These findings highlighted the need for age-specific approaches for effective tobacco control.
IMPLICATIONS
In this prospective investigation of a national cohort, older smokers (aged ≥55 years) who received varenicline did not have a greater point-prevalence abstinence after 6 months compared with those who used NRT patch or gum. Younger smokers (aged 25-54 years) who received varenicline had a greater likelihood of abstinence than NRT users. Sex and nicotine dependence did not modify the age-specific effectiveness of varenicline relative to NRT patch or gum. Age-appropriate approaches for effective tobacco control are needed.
介绍
在老年吸烟者中，与尼古丁替代疗法（NRT）相比，伐尼克兰戒烟的效果尚未得到研究。本研究前瞻性比较了伐尼克兰与 NRT 在 25-54 岁吸烟者中的疗效，分别在 55 岁或以上的吸烟者中进行了比较。
方法
在参加 2012-2015 年台湾戒烟计划的 13397 名吸烟者中，6336 名（≥55 岁，19.2%）接受了伐尼克兰治疗，7061 名（≥55 岁，23.2%）接受了 NRT 贴片或口胶治疗。参与者在 6 个月后通过电话访谈报告吸烟行为。Logistic 回归模型估计了 7 天、1 个月和 6 个月的点前戒烟率的优势比（OR）和 95%置信区间（CI）。年龄特异性模型调整了性别、教育程度、婚姻状况、吸烟年数、尼古丁依赖程度、医疗机构、就诊次数和药物使用时间。
结果
在 25-54 岁的吸烟者中，伐尼克兰使用者的点前戒烟率高于 NRT 使用者（例如，7 天点前戒烟率：34.0% vs. 23.5%），调整后的 OR 范围为 1.23（95%CI：1.09-1.39；6 个月点前戒烟率）至 1.37（95%CI：1.24-1.50；1 个月点前戒烟率）。在 55 岁或以上的吸烟者中，伐尼克兰和 NRT 使用者的点前戒烟率相似（例如，7 天点前戒烟率：32.3% vs. 33.1%），OR 并未表明伐尼克兰比 NRT 更有效。性别和尼古丁依赖程度并没有改变伐尼克兰相对于 NRT 的年龄特异性疗效。
结论
在这项对全国队列的前瞻性研究中，55 岁或以上的吸烟者使用伐尼克兰戒烟的效果并不优于 NRT，而 25-54 岁的吸烟者使用伐尼克兰的效果优于 NRT。这些发现强调了需要针对不同年龄组制定有效的烟草控制方法。
意义
在这项针对全国队列的前瞻性研究中，与使用尼古丁贴片或口胶的治疗相比，55 岁及以上的老年吸烟者在 6 个月后使用伐尼克兰并没有更高的点前戒烟率。使用伐尼克兰的年轻吸烟者（25-54 岁）比使用 NRT 贴片或口胶的吸烟者更有可能戒烟。性别和尼古丁依赖程度并没有改变伐尼克兰相对于 NRT 贴片或口胶的年龄特异性疗效。需要采取适合年龄的方法来有效控制烟草。
Zotero 插件