Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA.
Addict Behav. 2024 Apr;151:107952. doi: 10.1016/j.addbeh.2024.107952. Epub 2024 Jan 4.
Little is known about the mechanisms by which medication adherence promotes smoking cessation among adults with MDD. We tested the hypothesis that early adherence promotes abstinence by increasing behavioral treatment (BT) utilization.
Data for this post-hoc analysis were from a randomized trial of 149 adults with current or past MDD treated with BT and either varenicline (n = 81) or placebo (n = 68). Arms were matched on medication regimen. Early medication adherence was measured by the number of days in which medication was taken at the prescribed dose during the first six of 12 weeks of pharmacological treatment (weeks 2-7). BT consisted of eight 45-minute sessions (weeks 1-12). Bioverified abstinence was assessed at end-of-treatment (week 14). A regression-based approach was used to test whether the effect of early medication adherence on abstinence was mediated by BT utilization.
Among 141 participants who initiated the medication regimen, BT utilization mediated the effect of early medication adherence on abstinencea) an interquartile increase in early medication days from 20 to 42 predicted a 4.2 times increase in abstinence (Total Risk Ratio (RR) = 4.24, 95% CI = 2.32-13.37; p <.001); b) increases in BT sessions predicted by such an increase in early medication days were associated with a 2.7 times increase in abstinence (Indirect RR = 2.73, 95% CI = 1.54-7.58; p <.001); and c) early medication adherence effects on abstinence were attenuated, controlling for BT (Direct RR = 1.55, 95% CI = 0.83-4.23, p =.17).
The effect of early medication adherence on abstinence in individuals with current or past MDD is mediated by intensive BT utilization.
对于药物依从性如何促进成年人抑郁障碍（MDD）戒烟的机制知之甚少。我们检验了以下假设，即早期的药物依从性通过增加行为治疗（BT）的使用来促进戒烟。
本事后分析的数据来自一项针对 149 名目前或过去患有 MDD 的成年人的随机试验，这些成年人接受 BT 治疗，同时使用伐伦克林（n=81）或安慰剂（n=68）。药物治疗的前 12 周（第 2-7 周），以每天服用处方剂量的药物的天数来衡量早期药物依从性。BT 由 8 个 45 分钟的疗程组成（第 1-12 周）。治疗结束时（第 14 周）进行生物验证的戒烟评估。使用基于回归的方法来测试早期药物依从性对戒烟的影响是否由 BT 的使用来介导。
在开始药物治疗方案的 141 名参与者中，BT 的使用a）从早期药物天数的四分位数增加 20 到 42 预测了 4.2 倍的戒烟率（总风险比（RR）=4.24，95%置信区间（CI）=2.32-13.37；p<0.001）；b）BT 次数的增加，由早期药物天数的增加预测，与戒烟率的 2.7 倍增加相关（间接 RR=2.73，95%CI=1.54-7.58；p<0.001）；c）控制 BT 后，早期药物依从性对戒烟的影响减弱（直接 RR=1.55，95%CI=0.83-4.23，p=0.17）。
在当前或过去患有 MDD 的个体中，早期药物依从性对戒烟的影响是通过强化 BT 利用来介导的。
