哮喘联盟

   摘要
   许多戒烟药物疗法使戒烟率增加，对于公众健康有明显获益。在目前的药物治疗中，尼古丁替代疗法(NRT)是使用最长的、最多文献支持的治疗方法，也是非处方渠道的唯一选择。NRT的短期疗效在临床试验中得到了良好的证实；但由于大多数吸烟者会复吸，因此NRT的长期戒烟率一般。本文综述了提高NRT疗效的新临床策略。在文章开篇介绍了NRT概述和FDA批准的适应症后，笔者对随机试验中提高NRT疗效的几种临床处置方法进行了分析，包括：(1) 使用持续时间(戒烟前和延长使用)；(2) 使用剂量（高剂量和联合NRT）；(3) 针对特殊吸烟人群的调整治疗（基因型和表型）；(4) NRT使用新用途（预防复发、短暂戒烟、诱导戒烟）。同一领域内以及不同领域间有着不同的结果，笔者对其中更具治疗前景的领域加以了强调。NRT联合治疗有望成为最有价值的治疗策略；其他临床策略要么证据相矛盾还需要进一步试验(戒烟前NRT治疗或调整治疗)，要么其潜在功效需要进一步的直接验证。某些领域，基于其有限的研究未能提供很大的价值（高剂量和延长NRT治疗）。文章结尾部分，笔者对最终有可能提供比现有剂型更为强大疗效的新NRT产品（如经口尼古丁喷雾等）做了简短的讨论。为了进一步降低吸烟的流行，需要制定优化NRT疗效的新策略。
 

                                                                  (林江涛 审校)
Drugs. 2013 Apr 10. [Epub ahead of print]

 

Clinical Strategies to Enhance the Efficacy of Nicotine Replacement Therapy for Smoking Cessation: A Review of the Literature.
 

Carpenter MJ, Jardin BF, Burris JL, Mathew AR, Schnoll RA, Rigotti NA, Cummings KM.
 

Abstract
A number of smoking cessation pharmacotherapies have led to increases in quitting and thus to significant benefits to public health. Among existing medications, nicotine replacement therapy (NRT) has been available the longest, has the largest literature base in support, and is the only option for over-the-counter access. While the short-term efficacy of NRT is well documented in clinical trials, long-term abstinence rates associated with using NRT are modest, as most smokers will relapse. This literature review examines emerging clinical strategies to improve NRT efficacy. After an initial overview of NRT and its FDA-approved indications for use, we review randomized trials in which clinical delivery of NRT was manipulated and tested, in an attempt to enhance efficacy, through (1) duration of use (pre-quit and extended use), (2) amount of use (high-dose and combination NRT), (3) tailoring to specific smoker groups (genotype and phenotype), or (4) use of NRT for novel purposes (relapse prevention, temporary abstinence, cessation induction). Outcomes vary within and across topic area, and we highlight areas that offer stronger promise. Combination NRT likely represents the most promising strategy moving forward; other clinical strategies offer conflicting evidence but deserve further testing (pre-quit NRT or tailored treatment) or offer potential utility but are in need of further, direct tests. Some areas, though based on a limited set of studies, do not offer great promise (high-dose and extended treatment NRT). We conclude with a brief discussion of emergent NRT products (e.g., oral nicotine spray, among others), which may ultimately offer greater efficacy than current formulations. In order to further lower the prevalence of smoking, novel strategies designed to optimize NRT efficacy are needed.

Drugs. 2013 Apr 10. [Epub ahead of print]