SESSION TYPE: Tobacco Cessation and Prevention PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE:

Review some of the results analyzed in a Tobacco Cessation Consulting Room during 2008 and 2009.

METHODS:

Retrospective descriptive analysis of the results obtained from male patients who were attended in a Tobacco Consulting Room from January 1st in 2008 to December 31 in 2009 and the subsequent follow-up to complete a year.

RESULTS:

300 of 558 patients were males (53.7%), mean age 47.95 years (DE 11.76) and mean cigarettes/day 29.49 (DE 13.31). 77% tried to quit smoking at least once. Moderate-severe nicotine dependence (mean Fagerström 6.08 (DE 2.04)), high motivation (mean Richmond 8.22 (DE 1.35)) and mean initial cooximetry, 17.36 ppm (DE 9.35). Respiratory comorbidity, 30% (18.7% COPD, 6.7% asthma, 15.7% OSAHS and 1% HOT), cardiac comorbidity, 7.83% (IC 9.3% and arrhythmia 2.1%) and psychiatric, 29.7% (23.3% depression and/or anxiety). CVRF: 33% dyslipidemia, 25.3% HT and 12.7% DM. Of 300 male, 146 (48.7%) did not attend the second consultation. 30.5% without treatment, 43.9% NRT or bupropion and 25.6% varenicline. Success among respiratory patients was longer compared with cardiac (25% vs. 4%, non s.s) and among OSAHS males compared no-OSAHS (34.3% vs. 16.13, p<0.044). Those who were treated pharmacologically, greater success statistically significant among who used varenicline compared to NRT or bupropion (36.3% vs. 17.11%, p<0.034. Overall of the 300 males, treatment success in 47 (15.7%); if we do not consider those who did not attend the second consultation, of 154 males who were treated, percentage rises to 30.5%.

CONCLUSIONS:

1. Males showed moderate-severe nicotine dependence and high motivation 2. Severe comorbidity, especially psychiatric, respiratory and CVRF. 3. Greater success among respiratory than cardiac males. 4. Greater success s.s. among OSAHS males compared no-OSAHS. 5. Greater success among varenicline than NRT or bupropion-treated. 6. Overall treatment success 15.7%, amounting to 30.5% excluding those who do not attend the second consultation.

CLINICAL IMPLICATIONS:

When patients attend our Tobacco Cessation Consulting Room, they have often severe comorbidity. Smoking cessation treatment is effective but it requires patients commitment. There is an overall use of medication success of 15.7%, rising up to 30.5% if we exclude those who did not attend the second consultation. In our sample, males treated with varenicline showed a success rate higher than the ones treated with bupropion or nicotine replacement therapy.DISCLOSURE: The following authors have nothing to disclose: Francisco Javier Callejas Gonzalez, Javier Cruz Ruiz, Sergio Garcia Castillo, Mariela Plenc Ziegler, Abel Jesus Martinez Garcia, Juan Pastrana Calderon, Marta Genoves Crespo, Maria Dolores Garcia Jimenez, Ana Isabel Tornero Molina, Manuel Martinez RiazaNo Product/Research Disclosure InformationComplejo Hospitalario Universitario de Albacete, Albacete, Spain.

Bupropion is a norepinephrine dopamine-reuptake inhibitor that has been found to be effective in the treatment of nicotine dependence. Although well tolerated, seizures and psychosis have been described to occur with bupropion as severe adverse effects. We report the precipitation of acute psychosis with bupropion prescribed for smoking cessation in an elderly patient.

Chronic daily administration of nicotine and other drugs of abuse has been found to entrain pre- and post-drug circadian locomotor activity episodes that oscillate on a 24-h schedule and persist for several days after administration ceases. This drug-entrainable oscillator system could conceivably lead to circadian rhythms of drug seeking and drug use in human drug addicts. The present study (1) characterizes the ability of daily nicotine administration to entrain circadian wheel-running activity episodes in rats across a range of doses, lighting schedules, and food access; and (2) tests whether pre- and post-nicotine episodes can be altered through pharmacological manipulations. Adult female rats were housed in wheel boxes for 35-60 d, and both wheel-running and feeding-related behaviors were measured continuously. Following acclimation, nicotine or saline was administered for 16-24 d, and the rats were left undisturbed for several test days to observe the persistence of nicotine-entrained activity. The results showed that nicotine dose-dependently entrains wheel-running activity, and the highest dose of 1.0 mg/kg produces robust pre- and post-nicotine circadian activity episodes under constant, fixed, and variable light/dark schedules. In the pharmacological manipulation experiment, nicotine-entrained rats were administered one of seven pharmacological treatments (varenicline, mecamylamine, acamprosate, topiramate, naltrexone, SB-334867, or bupropion) in place of the nicotine injection for 2 d, and the rats were not disturbed for four subsequent days. Most of the treatment drugs significantly reduced post-nicotine activity episodes, but only three treatments affected pre-nicotine episodes: the μ- and κ-opioid receptor antagonist naltrexone, the orexin-1 receptor antagonist SB-334867, and the AMPA (2-amino-3-(3-hydroxy-5-methyl-isoxazol-4-yl)propanoic acid)/kainate antagonist topiramate. These results show that chronic daily nicotine administration is a robust zeitgeber that dose-dependently entrains a nonphotic oscillator system that includes opioid, orexin, and glutamate pathways.

Appropriate management of patients in pain clinics can be complex and sometimes confusing because providers must correctly interpret multiple sources of patient information. The correct interpretation of laboratory results is essential to guide subsequent patient treatment and management; however, laboratory and clinical pictures can appear to be conflicting in cases of substance abuse. Incorrect interpretation of laboratory results can multiply negative impacts on clinical outcomes and may lead to patient harm or death. This report introduces the complex nature involved in understanding and interpreting urine drug testing (UDT) results in pain patients who are prescribed opioid medications. Laboratory testing examples of UDT results are provided to illustrate the sometimes discordant nature of UDT interpretation. This case study describes one method of approaching cases where laboratory result interpretation in pain clinic patients is essential for medical treatment and management. The case presented in this manuscript illustrates a reconciliation of an opiate positive immunoassay result in a patient who was prescribed only OxyContin and Wellbutrin after traumatic amputations.

BACKGROUND:

The vesicular B0AT3 transporter (SLC6A17), one of the members of the SLC6 family, is a transporter for neutral amino acids and is exclusively expressed in brain. Here we provide a comprehensive expression profile of B0AT3 in mouse brain using in situ hybridization and immunohistochemistry.

RESULTS:

We confirmed previous expression data from rat brain and used a novel custom made antibody to obtain detailed co-labelling with several cell type specific markers. B0AT3 was highly expressed in both inhibitory and excitatory neurons. The B0AT3 expression was highly overlapping with those of vesicular glutamate transporter 2 (VGLUT2) and vesicular glutamate transporter 1 (VGLUT1). We also show here that Slc6a17mRNA is up-regulated in animals subjected to short term food deprivation as well as animals treated with the serotonin reuptake inhibitor fluoxetine and the dopamine/noradrenaline reuptake inhibitor bupropion.

CONCLUSIONS:

This suggests that the B0AT3 transporter have a role in regulation of monoaminergic as well as glutamatergic synapses.

OBJECTIVES:

: There is a critical need for the development of novel treatments for nicotine dependence. Because the majority of smokers who make a quit attempt fail within 7 days, medication screening procedures that focus on this early cessation period may provide an indicator of treatment efficacy. To establish the clinical validity of this paradigm, it is critical to demonstrate the association of early abstinence with longer-term abstinence. We tested the number of days of abstinence during the first week after the target quit date (TQD) as a predictor of point prevalence abstinence in 3 independent pharmacotherapy trials for nicotine dependence.

METHODS::

This was a secondary data analysis of 3 randomized clinical trials: a placebo-controlled trial of transdermal nicotine (N = 545); an open-label nicotine replacement therapy (patch vs spray) trial (N = 566); and a bupropion placebo-controlled trial (N = 538). In separate logistic regression models, the maximum number of consecutive days of abstinence during the first week after the TQD was used to predict biochemically verified 7-day point prevalence abstinence at the end of treatment (EOT) and 6 months post-TQD.

RESULTS::

Across the 3 trials, the number of days of abstinence significantly predicted abstinence at EOT and 6 months (odds ratios > 1.4; Ps < 0.0001). Likewise, not having any lapse during the first week predicted abstinence at EOT and 6 months (odds ratios > 4.7; Ps < 0.0001).

CONCLUSIONS::

The first week of abstinence was highly predictive of EOT and long-term abstinence. Medication screening procedures that focus on this early abstinence period (ie, 6 or 7 days of consecutive abstinence) represent a valid tool for assessing the presence of a signal for medication efficacy.

Binge-eating disorder (BED) is defined by recurrent binge eating (eating unusually large quantities of food during which a subjective loss of control is experienced), marked distress about the binge eating, and the absence of inappropriate weight compensatory behaviors. BED is strongly associated with excess weight, and many available psychological and pharmacologic approaches fail to produce much weight loss. The objective of this study was to perform a randomized placebo-controlled trial to evaluate the short-term efficacy of bupropion for the treatment of BED in overweight and obese women.Sixty-one overweight and obese (mean body mass index [BMI] = 35.8) women who met DSM-IV-TR research criteria for BED were randomly assigned to receive bupropion (300 mg/d) or placebo for 8 weeks. Participants were enrolled from November 2006 to December 2010. No dietary or lifestyle intervention was given. Primary outcome measures were binge-eating frequency and percent BMI loss. Secondary outcome measures were dimensional measures of eating disorder psychopathology, food craving, and depression levels.Eighty-nine percent (n = 54) of randomized participants completed the trial, without differential dropout between the bupropion and placebo groups. Mixed-effects analyses revealed significant time effects for all outcomes but no significant differences between bupropion and placebo on any outcome measure except for weight loss. Participants taking bupropion lost significantly more weight (1.8% vs 0.6% BMI loss; F = 10.57, P = .002).Bupropion was well tolerated and produced significantly greater-albeit quite modest-short-term weight loss in overweight and obese women with BED. Bupropion did not improve binge eating, food craving, or associated eating disorder features or depression relative to placebo. Our findings do not support bupropion as a stand-alone treatment for BED. The preliminary findings regarding short-term weight losses suggest the need for larger and longer-term trials to evaluate the potential utility of bupropion for enhancing outcomes of psychological interventions that have demonstrated effectiveness for BED but fail to produce weight loss.ClinicalTrials.gov identifier: NCT00414167.

Continued tobacco use in the setting of lung cancer management is frequently confounding and always of critical importance. We summarized the published literature concerning the management of tobacco dependence in patients with lung cancer and offer recommendations for integrating dependence treatment into ongoing oncologic care.MEDLINE, Embase, CINAHL, PsychINFO, and the Cochrane Collaborative databases were searched for English language randomized clinical trials, cohort studies, case-control studies, secular trend analyses, and case series relevant to the a priori identified clinical questions. Evidence grading, integration, and genesis of recommendations followed the methods described in "Methodology for Development of Guidelines for Lung Cancer" in the American College of Chest Physicians Lung Cancer Guidelines, 3rd ed.We describe the approach to tobacco dependence in patients with lung cancer at various phases in the evolution of cancer care. For example, among patients undergoing lung cancer screening procedures, we recommend against relying on the screening itself, including procedures accompanied solely by self-help materials, as an effective strategy for achieving abstinence. Among patients with lung cancer undergoing surgery, intensive perioperative cessation pharmacotherapy is recommended as a method for improving abstinence rates. Cessation pharmacotherapy is also recommended for patients undergoing chemotherapy, with specific recommendations to use bupropion when treating patients with lung cancer with depressive symptoms, as a means of improving abstinence rates, depressive symptoms, and quality of life.Optimal treatment of lung cancer includes attention to continued tobacco use, with abstinence contributing to improved patient-related outcomes at various phases of lung cancer management. Effective therapeutic interventions are available and are feasibly integrated into oncologic care. A number of important clinical questions remain poorly addressed by the existing evidence. CHEST 2013; 143(5)(Suppl):e61S-e77S.

Tobacco use is responsible for a large proportion of the total disease burden from tuberculosis. Pakistan is one of the 10 high-burden countries for both tuberculosis and tobacco use.To assess the effectiveness of a behavioral support intervention and bupropion in achieving 6-month continuous abstinence in adult smokers with suspected pulmonary tuberculosis.Cluster randomized, controlled trial. (Current Controlled Trials: ISRCTN08829879)Health centers in the Jhang and Sargodha districts in Pakistan.1955 adult smokers with suspected tuberculosis.Health centers were randomly assigned to provide 2 brief behavioral support sessions (BSS), BSS plus 7 weeks of bupropion therapy (BSS+), or usual care.The primary end point was continuous abstinence at 6 months after the quit date and was determined by carbon monoxide levels in patients. Secondary end points were point abstinence at 1 and 6 months.Both treatments led to statistically significant relative risks (RRs) for abstinence compared with usual care (RR for BSS+, 8.2 [95% CI, 3.7 to 18.2]; RR for BSS, 7.4 [CI, 3.4 to 16.4]). Equivalence between the treatments could not be established. In the BSS+ group, 275 of 606 patients (45.4% [CI, 41.4% to 49.4%]) achieved continuous abstinence compared with 254 of 620 (41.0% [CI, 37.1% to 45.0%]) in the BSS group and 52 of 615 (8.5% [CI, 6.4% to 10.9%]) in the usual care group. There was substantial heterogeneity of program effects across clusters.Imbalances in the urban and rural proportions and smoking habits among treatment groups, and inability to confirm adherence to bupropion treatment and validate longer-term abstinence or the effect of smoking cessation on tuberculosis outcomes.Behavioral support alone or in combination with bupropion is effective in promoting cessation in smokers with suspected tuberculosis.International Development Research Centre.

  Cynomolgus macaques, used in drug metabolism studies due to their evolutionary closeness to humans, are mainly bred in Asian countries, including Cambodia, China, and Indonesia. Cytochromes P450 (P450s) are important drug-metabolizing enzymes, present in liver and small intestine, major drug metabolizing organs. Previously, our investigation did not find statistically significant differences in hepatic P450 metabolic activities measured in cynomolgus macaques bred in Cambodia (MacfaCAM) and China (MacfaCHN). In the present study, P450 metabolic activity was investigated in small intestine of MacfaCAM and MacfaCHN, and cynomolgus macaques bred in Indonesia (MacfaIDN) using P450 substrates, including 7-ethoxyresorufin, bupropion, paclitaxel, diclofenac, S-mephenytoin, bufuralol, chlorzoxazone, and testosterone. The results indicated that P450 metabolic activity of small intestine was not statistically significantly different (< 2.0-fold) in MacfaCAM, MacfaCHN, and MacfaIDN. In addition, statistically significant sex differences were not observed (< 2.0-fold) in any P450 metabolic activity in MacfaCAM as supported by mRNA expression results. These results suggest that P450 metabolic activity of small intestine does not significantly differ statistically among MacfaCAM, MacfaCHN, and MacfaIDN.