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. 2015 Dec:51:93-9.
doi: 10.1016/j.addbeh.2015.07.019. Epub 2015 Jul 26.

Rate of nicotine metabolism and smoking cessation outcomes in a community-based sample of treatment-seeking smokers

Amanda Kaufmann  1 , Brian Hitsman  2 , Patricia M Goelz  1 , Anna Veluz-Wilkins  2 , Sonja Blazekovic  1 , Lindsay Powers  2 , Frank T Leone  3 , Peter Gariti  1 , Rachel F Tyndale  4 , Robert A Schnoll  5
Affiliations

Rate of nicotine metabolism and smoking cessation outcomes in a community-based sample of treatment-seeking smokers

Amanda Kaufmann et al. Addict Behav. 2015 Dec.

Abstract

Background: In samples from controlled randomized clinical trials, a smoker's rate of nicotine metabolism, measured by the 3-hydroxycotinine to cotinine ratio (NMR), predicts response to transdermal nicotine. Replication of this relationship in community-based samples of treatment-seeking smokers may help guide the implementation of the NMR for personalized treatment for nicotine dependence.

Methods: Data from a community-based sample of treatment seeking smokers (N=499) who received 8weeks of transdermal nicotine and 4 behavioral counseling sessions were used to evaluate associations between the NMR and smoking cessation. Secondary outcomes included withdrawal and craving, depression and anxiety, side effects, and treatment adherence.

Results: The NMR was a significant predictor of abstinence (OR=.56, 95% CI: 0.33-0.95, p=.03), with faster metabolizers showing lower quit rates than slower metabolizers (24% vs. 33%). Faster nicotine metabolizers exhibited significantly higher levels of anxiety symptoms over time during treatment, vs. slower metabolizers (NMR x Time interaction: F[3,357]=3.29, p=.02). NMR was not associated with changes in withdrawal, craving, depression, side effects, and treatment adherence (p's>.05).

Conclusions: In a community-based sample of treatment-seeking smokers, faster nicotine metabolizers were significantly less likely to quit smoking and showed higher rates of anxiety symptoms during a smoking cessation treatment program, vs. slower nicotine metabolizers. These results provide further evidence that transdermal nicotine is less effective for faster nicotine metabolizers and suggest the need to address cessation-induced anxiety symptoms among these smokers to increase the chances for successful smoking cessation.

Keywords: Anxiety; Biomarker; Nicotine dependence; Nicotine metabolite ratio; Pharmacogenetics; Smoking cessation.

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Figures

Figure 1
Figure 1
CONSORT Diagram Note. *A list of the reasons for participant ineligibility can be provided by the authors upon request.
Figure 2
Figure 2
Variation in Anxiety Symptoms Over Time for Slow and Fast Nicotine metabolizers and for Week 8 Abstainers and Smokers
See this image and copyright information in PMC

References

    1. Bough KJ, Lerman C, Rose JE, et al. Biomarkers for smoking cessation. Clin Pharmacol Ther. 2013;93(6):526–38. - PMC - PubMed
    1. Schnoll RA, Leone FT. Biomarkers to optimize the treatment of nicotine dependence. Biomark Med. 2011;5(6):745–61. - PMC - PubMed
    1. Lea RA, Dickson S, Benowitz NL. Within-subject variation of the salivary 3HC/COT ratio in regular daily smokers: prospects for estimating CYP2A6 enzyme activity in large-scale surveys of nicotine metabolic rate. J Anal Toxicol. 2006;30:386–389. - PubMed
    1. Ho MK, Mwenifumbo JC, Al Koudsi N, et al. Association of nicotine metabolite ratio and CYP2A6 genotype with smoking cessation treatment in African-American light smokers. Clin Pharmacol Ther. 2009;85(6):635–43. - PMC - PubMed
    1. Lerman C, Tyndale R, Patterson F, et al. Nicotine metabolite ratio predicts efficacy of transdermal nicotine for smoking cessation. Clin Pharmacol Ther. 2006;79(6):600–8. - PubMed

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