![Page 1: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/1.jpg)
Efficacy of Combination First Line Agents for Smoking Cessation
Sneha Baxi, Pharm.D.Pharmacy Practice Resident
University of Illinois at Chicago
![Page 2: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/2.jpg)
Session OutlineDiscuss effects of nicotine dependenceReview smoking cessation methodsPresent research project and resultsConclusionQuestions
![Page 3: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/3.jpg)
Statistics 440,000 American lives/year claimed by smoking related diseases$97.2 billion/year spent in health care costs and lost productivity87% of lung cancer cases are directly related to smoking80% of emphysema and chronic bronchitis cases related to smoking
http://www.lungusa.org/
![Page 4: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/4.jpg)
Deaths Attributed to Cigarette Smoking
http://www.lungusa.org/
![Page 5: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/5.jpg)
Addiction Potential
http://www.cdc.gov/tobacco/nicadd.htm
![Page 6: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/6.jpg)
Cessation MethodsColdTurkey/SelfHelpCounseling/Behavioral
NRT
Bupropion
Otherhttp://www.ahrq.gov/clinic/tobacco/
![Page 7: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/7.jpg)
Smoking Cessation Therapy
First Line Behavioral Modification Nicotine Replacement Therapy
Gum Inhaler Nasal spray Patch Lozenge
Bupropion sustained-release (SR)Second Line Nortriptyline, clonidine
![Page 8: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/8.jpg)
Monotherapy
http://www.cdc.gov/search.do?action=search&queryText=smoking+cessation+therapy+and+quit+rate
![Page 9: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/9.jpg)
Combination TherapyCombinations studiedNicotine patch and gumNicotine patch and nasal sprayNicotine patch and bupropion SRNicotine patch and inhaler
![Page 10: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/10.jpg)
Combination Therapy Abstinence Rates (6 months)
Combination Used Combination (%)
Monotherapy(%)
Patch & gum 27.5 15.3
Patch & gum 27.3 20.7Patch & nasal spray
31.4 16
Patch & inhaler 12.5 11.3Patch & bupropion 38.8 21.3 / 34.8
![Page 11: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/11.jpg)
Variables Associated with Abstinence
Variables associated with higher abstinence rates High motivation and confidence Ready to change Strong support system
Variables associated with lower abstinence rates High nicotine dependence History of psychiatric co-morbidity High stress level
http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat2.table.8634Table
10. Variables associated with higher or lower abstinence rates
![Page 12: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/12.jpg)
University of IllinoisSmoking Cessation ClinicPharmacist managedIndividual appointmentsReferred by other medical practitioners
![Page 13: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/13.jpg)
Initial Visit:Patient Interview
Medical problem listMedication list and allergiesSocial history identifying other current or past addictions, alcohol use, and occupationInsurance
![Page 14: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/14.jpg)
Smoking HistoryReasons why the smoker wants to quitPrevious quit attempts including length of success, time of last attempt, method used, and efficacy of methodBarriers to stopping smokingMotivation and confidence to quit smokingStage of change (pre-contemplation, contemplation, preparation, action, and maintenance)Smoking triggers
![Page 15: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/15.jpg)
Smoking History (cont.)Objective dataFagerstrom score Carbon monoxide readingBlood pressure, PulseWeight
![Page 16: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/16.jpg)
Assessment/PlanBehavioral recommendations Tally sheet to identify triggers Written trigger plan Stress and time management Healthy diet Educational smoking cessation book
Medication recommendations and educationFollow-up scheduled
![Page 17: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/17.jpg)
MedicationAdvantages and disadvantages of each medicationProper use, side effects, expectations, and cost of each medicationDemonstration of each medicationMedication education sheet(s)Prescription
![Page 18: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/18.jpg)
Research Project
![Page 19: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/19.jpg)
ObjectivesPrimary: Assess the efficacy of using combination therapy for smoking cessationSecondary: Identify specific patient populations that may benefit from combination therapy
![Page 20: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/20.jpg)
Study DesignResearch conducted at the University of Illinois Medical CenterIRB approvedRetrospective chart reviewGemini notesAccess data base
![Page 21: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/21.jpg)
MethodsRetrospective chart reviewEvaluate:Demographic dataMedical, medication, and smoking historyMotivation to quitTreatment Outcomes of therapy
![Page 22: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/22.jpg)
CriteriaInclusion Subjects seen at the
UIC Smoking Cessation clinic from January 2000-November 2004
Exclusion Minors (age < 18)
![Page 23: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/23.jpg)
Clinic Demographics: Age (n = 144)
0
10
20
30
40
50
20-29 30-39 40-49 50-59 60-69 > 70
# of
pa
tient
s
Age
![Page 24: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/24.jpg)
Clinic Demographics: Race
AACaucasianHispanicIndianOther
![Page 25: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/25.jpg)
Clinic Demographics: Gender
WomenMen
![Page 26: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/26.jpg)
Patient Characteristics: Smoking History
0
5
10
15
20
25
Number of Subjects
Pack Year History
<10
10-19
20-29
30-39
40-49
50-59
>60
![Page 27: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/27.jpg)
Patient Characteristics: Fagerstrom Score
05
101520253035404550
Fagerstorm Score
0 to 45 to 78 to 10
![Page 28: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/28.jpg)
Patient Characteristics:Co-Morbid Conditions
Medical Condition % Positive (n)
Diabetes Mellitus 20.4 (29)
COPD 10.6 (15)
Psychiatric 25.3 (36)
CAD 10.6 (15)
Seizures 11.3 (16)
Other Addictions 10.6 (15)
![Page 29: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/29.jpg)
Subjects Abstinent > 6 Months: Demographics
Characteristic Monotherapy(n = 12)
Combination(n = 9)
Age (mean)Race (% AA)Sex (% female)
54.866.6 (n = 8)66.6 (n = 8)
47.755.5 (n = 5)77.7 (n = 7)
Co-Morbidities (%) DM COPD Psych CAD Seizures Addictions
2533.325816.60
44.422.233.3022.211.1
![Page 30: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/30.jpg)
Subjects Abstinent > 6 Months: Smoking History
Characteristic Monotherapy(n = 12)
Combination(n = 9)
Pack Year History (mean)
33.7 34.3
Fagerstorm Score (mean)
3.12 4.3
Baseline CO Reading (mean)
13 12.3
![Page 31: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/31.jpg)
MonotherapyMethod # Subjects
(n=120)6 Month Success
Rate % (n=12)
Cold Turkey 90 3.3 (3)
Patch 10 40 (4)
Gum 2 50 (1)
Nasal Inhaler 5 0
Nasal Spray 2 50 (1)Lozenges 3 33.3 (1)
Bupropion 8 25 (2)
![Page 32: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/32.jpg)
Combination TherapyMethod # Subjects
(n= 24)6 Month Success
Rate % (n=9)
Patch + Inhaler 12 33.3 (4)
Patch + Gum 4 25 (1)
Patch + Spray 1 100 (1)
Patch + Bupropion 2 0 (0)
Inhaler + Bupropion 4 50 (2)
Inhaler + Gum 1 100 (1)
![Page 33: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/33.jpg)
ConclusionsHigher percentage of patients were able to quit for at least 6 months in the combination therapy group versus the monotherapy groupSmoking tobacco quit rate similar to national averages
![Page 34: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/34.jpg)
LimitationsLow number of subjects in studyRetrospective studyNo randomization
![Page 35: Efficacy of Combination First Line Agents for Smoking Cessation Sneha Baxi, Pharm.D. Pharmacy Practice…](https://reader036.vdocument.in/reader036/viewer/2022062601/5a4d1bf87f8b9ab0599ea53f/html5/thumbnails/35.jpg)
QUESTIONS?