Clinical trial NCT03227679: Metabolism-informed Care for Smoking Cessation
Official title: Metabolism-informed Care for Smoking Cessation
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Tobacco Use
Tobacco Use Cessation
Keywords: Personalized Medicine
Nicotine Metabolite Ratio (NMR)
Varenicline
Nicotine Replacement Therapy (NRT)
Smoking Cessation
Pharmacotherapy
Lead sponsor: Vanderbilt University Medical Center
Sponsor class: OTHER
First posted: 2017-07-24
Enrollment: 82
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Intervention model description: Parallel arm pilot trial with a single-arm crossover design
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Nicotine mediates smoking's addictive effects in the brain. The ratio of 3-hydroxycotinine to cotinine, known as the nicotine metabolite ratio, or NMR, is a genetically- informed biomarker reflecting hepatic CYP2A6 activity and the rate of nicotine metabolism. In light of a recent randomized controlled trial (RCT) in humans in Lancet Respiratory Medicine, which found that the NMR can be used to individualize treatment for smokers, our pilot study aims to determine the feasibility of using NMR to guide selection of pharmacotherapy in clinical populations of daily smokers.

Detailed description: Consenting participants will be assigned to guideline-based care (GBC: incorporating national guidelines and more recent evidence from clinical trials of pharmacotherapy for smoking cessation) or metabolism-informed care (MIC: identical to GBC but selection of medication based on NMR result). All participants received counseling from a nurse level certified tobacco counseling. After consent, participants undergo a blood draw for NMR, complete a baseline questionnaire, and are randomized to GBC or MIC. At approximately 1, 3, and 6 months post-consent, participants will provide follow up information via telephone questionnaire regarding symptoms, confidence in quitting, use of medications, and smoking status. At the 6-month follow-up time point, if a participant self-reports abstinence from smoking, the participant will be asked to complete a survey in-person and provide a sample of end-expired carbon monoxide for biochemical validation. At the 6 month time point, GBC participants who continue to smoke will be offered an additional phone call from the nurse tobacco counselor in which the results of the baseline NMR test will be given, along with a second prescription for a smoking cessation medication based on the NMR results (i.e., single arm crossover design). Two weeks after this additional phone call, the patient will be contacted for a final survey regarding use of medication and smoking status.

Eligibility criteria: Inclusion Criteria:

* 18 years or older
* Smokes ≥ 5 cigarettes per day
* Willing to give up all forms of tobacco (5/10/2016 - 6/27/2016)
* Medically cleared (i.e., no contraindications in Section 3) to receive at least 2 FDA- approved smoking cessation medications
* Willing to use the medications for which medically cleared (individually, not in combination; only applicable if Medically Cleared = Yes)

Exclusion Criteria:

* Current diagnosis of schizophrenia, psychosis, active suicidal ideation, dementia, or severe mental retardation
* Receiving palliative or hospice care
* Currently pregnant or breastfeeding
* Hospitalized for a psychiatric condition in the past year (5/10/2016 - 6/27/2016)
* Hospitalized for a psychiatric condition in the past 3 months or change in psychiatric medications in last 3 months (6/28/2016 forward)
* Telephone problems that would preclude participation (e.g., can't receive calls reliably)
* Not able to read and speak English
* Abstinent from cigarettes for \>3 days (b/c NMR not reliable after 72 hours)
* Used smoking cessation medications in the last 7 days (5/10/2016 - 6/27/2016)

Primary outcomes:
measure: Theoretical Endorsement of MIC as assessed by level of agreement to a set of seven 5-point Likert Scale questions
timeFrame: Baseline
measure: Acceptance of MIC medication recommendation as assessed by concordance between MIC recommendation and actual prescribed medication
timeFrame: At 4 weeks post-baseline
Secondary outcomes:
measure: Confidence in Quitting
timeFrame: Baseline - 6 months
measure: Medication Use/Compliance
timeFrame: 1 - 6 months
measure: Smoking Status
timeFrame: 6 months
Other outcomes:
Locations:
Study officials:
affiliation: Vanderbilt University Medical Center
name: Quinn Wells, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Vanderbilt University Medical Center
name: Dawn Beaulieu, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Vanderbilt University Medical Center
name: Matthew Freiberg, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Vanderbilt University Medical Center
name: Hilary Tindle, MD
role: PRINCIPAL_INVESTIGATOR
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