From nicotine patches to smoking cessation pills, there are dozens of treatments already available for smokers who wish to quit. However, a new Penn-led study may allow individuals to find the treatment that best suits their genetic needs.
An international research team led by Psychiatry professor Caryn Lerman was awarded $12 million from the National Institute of Health to study personalized smoking cessation treatments in a 1,350-person clinical trial.
With the first participants to be enrolled this fall, the five-year study will analyze subjects’ nicotine metabolite ratio (NMR), a “genetically-informed biomarker” that indicates the rate at which individuals’ bodies break down nicotine. Researchers will use NMR levels to determine what form of smoking cessation treatment — either patch or pill — would be most effective on an individual basis.
NMR was previously studied by Lerman and her team in a series of four Pharmacogenetics of Nicotine Addiction Treatment studies from 1999 to 2009. However, these studies differed from the team’s current project because they only analyzed patients after treatment.
“This new study takes the next important step towards translating this marker research to practice,” Lerman said, as it tests subjects before treatment.
The team will study one group of individuals with the slow nicotine metabolizer and another with the normal, more common metabolizer. Individuals will be randomly assigned to receive a placebo, nicotine patch or Pfizer’s Chantix, otherwise known as varenicline, a medication used to treat smoking addiction.
Once the test is performed on subjects, Professors of Medicine Daniel Polsky and Henry Glick, along with Biostatistics and Statistics professor Daniel Heitjan, will conduct cost-effectiveness analysis in order to assess the long-term savings associated with personalized smoking cessation treatments.
The researchers believe that if the NMR test can extend lifespan a few months and save several hundred dollars, it would be “quite worthwhile,” Heitjan said.
According to both Heitjan and Polsky, while cost-effectiveness analysis may not be widespread throughout scientific studies, it is gaining momentum.
“It’s becoming increasingly important because of all the emphasis on cost savings in the health system,” Heitjan said.
Of the three study treatments, the varenicline pill is the most costly. However, as Polsky pointed out, “if you could find those people for whom a patch would be just as effective, it would cost less.”
With long-term cost and smoking cessation permanence in mind, the researchers hope to translate the clinical trial to practice by “understanding what the real world implications would be,” Polsky said.
