Creating a Personalized Smoking Cessation Pharmacotherapy Program in Smokers with Crohn's Disease Utilizing Nicotine Metabolite Ratio (NMR)

Abstract Introduction Smokers who use opioids smoke more cigarettes per day (CPD) than non-opioid users, which could be due to the effects of opioids on nicotine metabolism. Moreover, nicotine metabolism increases during pregnancy, potentially making quitting more difficult for pregnant smokers. We examined nicotine metabolism and its association with opioid use (OU) and CPD in pregnant smokers. Methods We recruited pregnant women who smoked at least 5 CPD for a clinical trial of smoking cessation. Plasma nicotine metabolite ratio (NMR; trans-3′-hydroxycotinine (3HC)/cotinine)—a biomarker of nicotine metabolism—OU (involving methadone, buprenorphine, fentanyl, oxycodone, or tramadol), and CPD were assessed at baseline. We used linear regression to examine the associations between log-transformed NMR, OU, and CPD, adjusting for race/ethnicity and menthol smoking. Results Among 129 pregnant smokers, 25 (19%) were opioid users; most were maintained on methadone (n = 14). Compared to non-OU smokers, OU smokers had higher median CPD (10.0 vs. 7.0, p = .0007), serum 3HC (81.0 vs. 42.0 ng/mL, p = .0001), and NMR (0.63 vs. 0.43, p < .0001). In addition, methadone-maintained smokers had a higher median NMR than non-OU smokers (0.66 vs. 0.43, p = .0004). Adjusting for covariates, log-transformed NMR was greater in OU smokers (p = .012), specifically methadone-maintained smokers (p = .024), than non-OU smokers. Conclusions Our preliminary results show that OU is associated with a higher NMR in pregnant smokers. A larger study sample is needed to replicate this finding, examine potential mechanisms, and determine its clinical significance. Implications Among pregnant smokers, we observed that nicotine metabolism was significantly faster among opioid users—the majority of whom were on methadone maintenance—compared to nonusers, which could have implications for smoking cessation. Further studies are needed to replicate this finding, evaluate potential mechanisms, and determine its clinical significance.

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Smoking cessation improves Crohn's disease outcomes regardless of the use of anti-TNF or immunomodulator

Evidence-Based Medicine ◽

10.1136/ebmed-2016-110465 ◽

2016 ◽

Vol 21 (4) ◽

pp. 153-153 ◽

Cited By ~ 2

Author(s):

Rupert W Leong ◽

Aladdin O Alswaifi

Keyword(s):

Smoking Cessation ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Outcomes

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Nicotine metabolite ratio and smoking outcomes using nicotine replacement therapy and varenicline among smokers with and without psychiatric illness

Journal of Psychopharmacology ◽

10.1177/0269881118773532 ◽

2018 ◽

Vol 32 (9) ◽

pp. 979-985

Author(s):

Matthew Clyde ◽

Andrew Pipe ◽

Charl Els ◽

Robert Reid ◽

Angel Fu ◽

...

Keyword(s):

Smoking Cessation ◽

Replacement Therapy ◽

Nicotine Replacement Therapy ◽

Odds Ratio ◽

Supporting Evidence ◽

Nicotine Replacement ◽

Psychiatric Status ◽

Metabolite Ratio ◽

Psychiatric Conditions ◽

Nicotine Metabolite Ratio

Introduction: It has been suggested that the effectiveness of nicotine replacement smoking cessation pharmacotherapy may be enhanced by assessing rates of nicotine metabolism using the nicotine metabolite ratio – which reflects differences in the activity of the CYP2A6 hepatic enzyme – and titrating doses appropriately. To date, supporting evidence is equivocal, with little information regarding the assessment and effectiveness of the nicotine metabolite ratio among smokers with psychiatric conditions. Methods: The nicotine metabolite ratio of 499 smokers from the FLEX trial was determined using urine samples obtained at baseline. They were randomized to receive either: standard transdermal nicotine (nicotine replacement therapy); extended nicotine replacement therapy + adjunct nicotine agent; or varenicline. Primary cessation outcomes were seven-day point prevalence at 5, 10, 22, and 52 weeks post-target quit date, comparing across treatment and psychiatric status. Our principal analysis employed logistic regression (outcome: abstinence), using slow metabolizers as the reference category. Results: No differences were observed by nicotine metabolite ratio classification (slow, moderate, fast) with respect to any demographic or smoking-related variables. Nicotine metabolite ratio class did not predict smoking cessation in either the overall sample, or by treatment condition at any time-point (week 52 moderate metabolizers: odds ratio 1.34, 95% confidence interval (0.68–2.63), p=0.394; fast metabolizers: odds ratio 1.04 (0.56–1.91), p=0. 906). Conclusion: Our results did not find any associations between nicotine metabolite ratio and cessation outcomes among smokers using nicotine replacement therapy or varenicline with and without lifetime psychiatric conditions.

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