The Frequency of Prescribing Nicotine and Varenicline in a Public Hospital

Aim: This study was conducted to demonstrate the prescribing pattern of nicotine and varenicline in a public hospital in Alkharj. Methodology: This is a retrospective study includes evaluating outpatient prescribing of nicotine and varenicline from 1st of January 2018 to 30th of June 2018 in a public hospital in Alkharj. Results: All of the nicotine patch prescriptions were written by internal medicine department and all of the prescriptions were prescribed by residents. The age of more than half of them was between 30 and 39 (53.33%). All of the varenicline tablet prescriptions were written by internal medicine department. The age of about 88.23% of the patients who received varenicline tablet was more than 29 years. Conclusion: Nicotine and varenicline prescribing was infrequent in Al-kharj. More awareness programs are needed for health care workers and for the public. Moreover, the physicians should assess if the treatment is needed or no according to the person condition.

Active smokers show ameliorated delayed gastric emptying after pancreatoduodenectomy

Background Delayed gastric emptying (DGE) is the most common complication following pancreatoduodenectomy (PD). The data about active smoking in relation to gastric motility have been inconsistent and specifically the effect of smoking on gastric emptying after PD has not yet been investigated in detail. Methods 295 patients at our department underwent PD between January 2009 and December 2019. Patients were analyzed in relation to demographic factors, diagnosis, pre-existing conditions, intraoperative characteristics, hospital stay, mortality and postoperative complications with special emphasis on DGE. All complications were classified according to the definitions of the International Study Group on Pancreatic Surgery. Results 274 patients were included in the study and analyzed regarding their smoking habits (non or former smokers, n = 88, 32.1% vs. active smokers, n = 186, 68.6%). Excluded were patients for whom no information about their smoking habits was available (n = 3), patients who had had gastric resection before (n = 4) and patients with prolonged postoperative resumption to normal diet independently from DGE (long-term ventilation > 7 days, fasting due to pancreatic fistula) (n = 14). Smokers were younger than non-smokers (61 vs. 69 years, p ≤ 0.001) and mainly male (73% male vs. 27% female). Smoking patients showed significantly more pre-existing pulmonary conditions (19% vs. 8%, p = 0.002) and alcohol abuse (48% vs. 23%, p ≤ 0.001). We observe more blood loss in smokers (800 [500–1237.5] vs. 600 [400–1000], p = 0.039), however administration of erythrocyte concentrates did not differ between both groups (0 [0–2] vs. 0 [0–2], p = 0.501). 58 out of 88 smokers (66%) and 147 out of 186 of non-smokers (79%) showed malign tumors (p = 0.019). 35 out of 88 active smokers (40%) and 98 out of 188 non- or former smokers (53%) developed DGE after surgery (p = 0.046) and smokers tolerated solid food intake more quickly than non-smokers (postoperative day (POD7 vs. POD10, p = 0.004). Active smokers were less at risk to develop DGE (p = 0.051) whereas patients with pulmonary preexisting conditions were at higher risk for developing DGE (p = 0.011). Conclusions Our data show that DGE occurs less common in active smokers and they tolerate solid food intake more quickly than non-smokers. Further observation studies and randomized, controlled multicentre studies without the deleterious effect of smoking, for instance by administration of a nicotine patch, are needed to examine if this effect is due to nicotine administration.

New Biomarkers Based on Smoking-Related Phenotypes for Smoking Cessation Outcomes of Nicotine Replacement Therapy: A Prospective Study

Introduction: Identification of a potent biomarker related to smoking cessation can play a key role in predicting prognosis and improving treatment outcomes. This study aimed to evaluate the contribution of new biomarkers based on levels of cotinine (Cot) and/or carbon monoxide (CO) to the short- and long-term quit rates of nicotine replacement therapies (nicotine patch (NP) and nicotine lozenge (NL)). Methods: In this prospective interventional study, a sample of 124 smokers under treatment with the 5A's method was selected between April 2016 and December 2018 in an outpatient smoking cessation center in 18th region of Tehran. They were divided into two groups for NP (n = 56) and NL (n = 61) interventions. The levels of Cot and CO were measured using ELISA and breath analysis at the beginning of the study. Three markers were calculated: Cot/CO, Cot to cigarette per day ratio (Cot/CPD), and CO/CPD. To determine the odds of smoking cessation success, binary logistic regression models and generalized estimating equations (GEE) model were analyzed by SPSS software. Results: Of the NP participants, 30.4% and 19.6% were abstinent in 2 and 6 months respectively, while NL was found less effective with 19.7% for 2-month follow-up and 13.1% for 6-month follow-up. The 6-month success of attempts to quit was significantly different for the NP participants at the second half of Cot/CO (P = 0.029). In the NL participants, CO/CPD would be a superior predictor for the success of smoking cessation (P > 0.05). Conclusions: The findings of this study suggested two markers, Cot/CO and CO/CPD in order, for the optimum treatment outcomes of NP and NL.

Exenatide Adjunct to Nicotine Patch Facilitates Smoking Cessation and May Reduce Post-Cessation Weight Gain: a Pilot Randomized Controlled Trial

Introduction Approved pharmacological treatments for smoking cessation are modestly effective, underscoring the need for improved pharmacotherapies. Glucagon-like peptide-1 receptor (GLP-1R) agonists attenuate the rewarding effects of nicotine in preclinical studies. We examined the efficacy of extended-release exenatide, a GLP-1R agonist, combined with nicotine replacement therapy (NRT, patch) for smoking cessation, craving and withdrawal symptoms, with post-cessation body weight as secondary outcome. Methods Eighty-four prediabetic and/or overweight smokers were randomized (1:1) to once-weekly placebo or exenatide, 2 mg, subcutaneously. All participants received NRT (21 mg) and brief smoking cessation counseling. Seven-day point prevalence abstinence (expired CO level ≤5 ppm), craving, withdrawal and post-cessation body weight were assessed following 6 weeks of treatment. A Bayesian approach for analyzing generalized linear models yielded posterior probabilities (PP) to quantify the evidence favoring hypothesized effects of treatment on the study outcomes. Results Exenatide increased the risk for smoking abstinence compared to placebo (46.3% and 26.8%, respectively), (RR = 1.70; 95% credible interval = [0.96, 3.27]; PP = 96.5%). Exenatide reduced end-of-treatment craving in the overall sample and withdrawal among abstainers. Post-cessation body weight was 5.6 pounds lower in the exenatide group compared to placebo (PP=97.4%). Adverse events were reported in 9.5% and 2.3% of participants in the exenatide and placebo groups, respectively. Conclusions Exenatide, in combination with the NRT improved smoking abstinence, reduced craving and withdrawal symptoms, and decreased weight gain among abstainers. Findings suggest that the GLP-1R agonist strategy is worthy of further research in larger, longer duration studies. Implications Despite considerable progress in tobacco control, cigarette smoking remains the leading cause of preventable disease, disability, and death. In this pilot study, we showed that extended-release exenatide, a glucagon-like peptide-1 receptor agonist, added to the nicotine patch, improved abstinence and mitigated post-cessation body weight gain compared to patch alone. Further research is needed to confirm these initial positive results.