rows director of the centre for nicotine and smoking cessation research at duke university medical

centre

our mission is to better understand tobacco addiction and to develop treatments that enables smokers

to kick their addiction to cigarettes more effectively

current treatments unfortunately have a rather low long term success rate so nicotine patch beginning

other forms of nicotine replacement

generally you old about ten percent success in the long run

the prescription a is she antics

and side we had are approximately the same and so we've been looking at ways

to try to increase

the success rates with

smoking cessation treatment using personalised an adaptive treatment approaches so personalised meeting to take their

the treatment to the individual smoker

based on either the genetic or other characteristics

and then adaptive treatment which changes the treatment depending on how the smoker is responding

in terms of inner groovy markers of

success or failure

i was recently at a meeting a week ago in toronto these decide for research

on nicotine tobacco presenting the results from our latest study

and in that study we started

smokers who wanted to quit on a nicotine patch we take that those the patch

depending on how heavy smoker they were so they would either where one patch giving

standard those of twenty one milligrams nicotine today which replaces about the nicotine of that

the cigarettes smoked daily

but for the heavy smokers they started wearing two patches today

now they started wearing catches even as they continue to smoke for two week period

because in previous research we found that starting that actually for the with a

i improves success rates smokers while smoking on the patch will reduce their smoking often

and in previous research the people who

spontaneously we use the smoking both do not have the best success rates when they

reach their target state and quit smoking entirely

so in this study we measured carbon monoxide which is an index of how much

they're smoking after one week of wearing their nicotine patches

for smokers whose carbon monoxide levels fell by more than fifty percent

indicative of a substantial decrease in smoking

we let them stay on the patch because

they had a very good chance of succeeding in quitting smoking in fact the success

rates were over fifty percent which is very high in this field and that was

a that we committed weeks nineteen twelve after the rotate

for the smokers on the other hand did not show any be reduction in the

smoking on that first week were wearing making catches

we randomized those smokers to run three different treatments

one treatment was the switch them to frantically in or channel text

the other ways to augment their the key patch with p probably a or slightly

and the f t allows

side and used with the couch whereas with can takes they have not to the

combination so that's why we switch people which antics or in the case of the

second treatment added

so i've and on top of the patch and then the third rule

was randomized just staying on same nicking patch treatment that they were are

these treatments were given double blind so everybody were patches and two bills and capsules

but in some cases they've received a active patches bills in other cases placebo

well we found once again the

the smokers who did not show and early response to the patch in the first

week in terms of

greatly reducing their smoking part accent levels if they were that's all the edge they

had a very low success rate that's and ten percent

however

a for those smokers who did not respond initial patch and you were switched either

true channel six or a received augmentation of their treatment by the addition of the

side and they did substantially better are we rescue to speak about fifteen percent

them we would have otherwise almost certainly fails if left on patch lighting's which to

one of the other rescue treatment so that illustrates the adaptive nature of the treatment

is to

star people on the nicotine patch which is the safest most well tolerated treatment

l along with it at the kinds of nicotine replacement and then depending on the

early marker of smoking reduction measured by the carbon monoxide this study

if we identify people who are almost certain to fail at that point then we

bring in the potential recipe treatments in the form of the prescription pharmaceuticals

a it makes sense we feel to start people and they can catch again because

it's very safe and well tolerated and then bring in the prescription a switch while

generally save you have are the potential of rare but serious side effects adverse reactions

as it rescue treatment if people are not responding

well to the nicotine

replacement initially

the second aspect of this study aside from adapting the treatment based on the really

markers of a response to the nicotine patch was to try to determine whether the

genetic nature genetic

constitution of people would also predict

their outcome previously with colleagues at the national institute on track of used contort will

and colleagues we've identified genetic markers they do project

how likely is the someone will

six c in quitting smoking

there were twelve thousand markers that were identified out of a billion markers on the

you know that we examined

in previous work

and we used information from those twelve thousand markers to come up with a single

score

which we correlate with success score and this was obtained by adding up or averaging

the favourable or unfavourable markers at each of these twelve thousand locations

so someone of at feast favorable version of the gene more likely to predict success

would receive a higher score than someone would have less capable of markers at these

locations

a that it was a single number of single score derived from these many genetic

markers

and we've found also the this genetic score predicted

six that's in the study where we use the adaptive treatment change

and the predictive nist of this score added to the productiveness their smoking reduction while

on the patch in terms of adding more information to allow us to gain choose

more likely to six c

so ultimately what we hope to do is to put together the information from genetics

other information about the person's age gender smoking habits and so forth in order to

that we predict how likely the origins c

but to determine whether specific treatment is more likely to work for one person that

another

and incorporate that into an adaptive treatment strategy that alters treatment depending on how smokers

are responding

we're now wanting a followup study in which one of the potential rescue treatments for

smokers don't respond in terms of smoking reduction cash will be the combination of frantically

and you probably a chance six and side because some work suggests that since these

two different

agents act by different mechanisms that adding both treatments could further enhance success rates and

again a our strategy will be to apply that kind of

intensive pharmacological treatment the to the people who don't respond initially in terms of the

favourable response to take a patch so this way hopefully a step by step we

will be developing more and more effective treatments that enable smokers to quit and remain

abstinent because previous

studies have shown that if a smoker does quit they will reduce the chances of

dying from smoking related diseases from fifty percent chance smokers have about a fifty percent

chance of dying of disease from their smoking but if they quit smoking depending on

how

younger role they are when they quit on average they lose about half of that

excess risk and therefore will be more likely longer and healthier life