Rapid Nicotine Metabolite Ratio and Successful Quitting: Acceptable Explanation

Rapid Nicotine Metabolite Ratio and Successful Quitting: Acceptable Explanation Nicotine & Tobacco Research, 2018, 908 doi:10.1093/ntr/ntx188 Letter Letter Rapid Nicotine Metabolite Ratio and Successful Quitting: Acceptable Explanation Tomoyuki Kawada MD Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan Corresponding Author: Tomoyuki Kawada, MD, Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo 113–8602, Japan. Telephone: 81-3-3822-2131; Fax: 81-3-5685-3065; E-mail: kawada@nms.ac.jp Drs. Fix and colleagues examined the relationship between nico- inclusions of mean cotinine levels in current smokers and quitters tine metabolite ratio (NMR) and smoking abstinence. The ratio of should be presented in their Table 2. trans 3’-hydroxycotinine to cotinine was calculated as a biomarker Finally, chronic alcohol abuse might increase the rate of nicotine of NMR. Although higher NMR was associated with higher daily metabolism. As there is an ethnic difference of alcohol intake, alco- cigarette consumption and considered to be less success for smoking hol information should be included for the analysis. cessation, adjusted odds ratio (95% confidence interval) of smokers with a higher NMR against those with a lower NMR for success- References ful quitting was 2.48 (1.23–4.99). The authors concluded that faster nicotine metabolizers might be less likely to relapse following a quit 1. Fix BV, O’Connor RJ, Benowitz N, et al. Nicotine metabolite attempt, which was inconsistent with data from past clinical trials. ratio (NMR) prospectively predicts smoking relapse: longitudi- I have some concerns about their study. nal findings from ITC Surveys in five countries. Nicotine Tob Res. First, the authors observed 67 successful quitters from 871 sub- 2017;19(9):1040–1047. jects. There is a significant variation in NMR across five countries, 2. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J and two countries showed significant decrease in odds ratio against Clin Epidemiol. 1996;49(12):1373–1379. United States for successful quitting. In addition, 27 quitters showed 3. Novikov I, Fund N, Freedman LS. A modified approach to estimating sam - 6  months or shorter periods of quitting. As there is a variation ple size for simple logistic regression with one continuous covariate. Stat of quitting period and ethnic difference, stratified analysis is also Med. 2010;29(1):97–107. needed. In general, the number of events per independent variable by 4. Kauffman RM, Ferketich AK, Murray DM, Bellair PE, Wewers ME. 2,3 multiple logistic regression analysis should be ≥10, and 90 events Measuring tobacco use in a prison population. Nicotine Tob Res. are needed for stable estimates. 2010;12(6):582–588. Second, the authors evaluated successful quitting by a self-report. 5. Gubner NR, Kozar-Konieczna A, Szoltysek-Boldys I, et  al. Cessation of As salivary cotinine measured by liquid chromatography/tandem alcohol consumption decreases rate of nicotine metabolism in male alco- mass spectrometry is the most accurate method for tobacco use, hol-dependent smokers. Drug Alcohol Depend. 2016;163:157–164. © The Author(s) 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. 908 For permissions, please e-mail: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ntr/article-abstract/20/7/908/4379806 by Ed 'DeepDyve' Gillespie user on 21 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Nicotine and Tobacco Research Oxford University Press

Rapid Nicotine Metabolite Ratio and Successful Quitting: Acceptable Explanation

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© The Author(s) 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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10.1093/ntr/ntx188
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Abstract

Nicotine & Tobacco Research, 2018, 908 doi:10.1093/ntr/ntx188 Letter Letter Rapid Nicotine Metabolite Ratio and Successful Quitting: Acceptable Explanation Tomoyuki Kawada MD Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan Corresponding Author: Tomoyuki Kawada, MD, Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo 113–8602, Japan. Telephone: 81-3-3822-2131; Fax: 81-3-5685-3065; E-mail: kawada@nms.ac.jp Drs. Fix and colleagues examined the relationship between nico- inclusions of mean cotinine levels in current smokers and quitters tine metabolite ratio (NMR) and smoking abstinence. The ratio of should be presented in their Table 2. trans 3’-hydroxycotinine to cotinine was calculated as a biomarker Finally, chronic alcohol abuse might increase the rate of nicotine of NMR. Although higher NMR was associated with higher daily metabolism. As there is an ethnic difference of alcohol intake, alco- cigarette consumption and considered to be less success for smoking hol information should be included for the analysis. cessation, adjusted odds ratio (95% confidence interval) of smokers with a higher NMR against those with a lower NMR for success- References ful quitting was 2.48 (1.23–4.99). The authors concluded that faster nicotine metabolizers might be less likely to relapse following a quit 1. Fix BV, O’Connor RJ, Benowitz N, et al. Nicotine metabolite attempt, which was inconsistent with data from past clinical trials. ratio (NMR) prospectively predicts smoking relapse: longitudi- I have some concerns about their study. nal findings from ITC Surveys in five countries. Nicotine Tob Res. First, the authors observed 67 successful quitters from 871 sub- 2017;19(9):1040–1047. jects. There is a significant variation in NMR across five countries, 2. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J and two countries showed significant decrease in odds ratio against Clin Epidemiol. 1996;49(12):1373–1379. United States for successful quitting. In addition, 27 quitters showed 3. Novikov I, Fund N, Freedman LS. A modified approach to estimating sam - 6  months or shorter periods of quitting. As there is a variation ple size for simple logistic regression with one continuous covariate. Stat of quitting period and ethnic difference, stratified analysis is also Med. 2010;29(1):97–107. needed. In general, the number of events per independent variable by 4. Kauffman RM, Ferketich AK, Murray DM, Bellair PE, Wewers ME. 2,3 multiple logistic regression analysis should be ≥10, and 90 events Measuring tobacco use in a prison population. Nicotine Tob Res. are needed for stable estimates. 2010;12(6):582–588. Second, the authors evaluated successful quitting by a self-report. 5. Gubner NR, Kozar-Konieczna A, Szoltysek-Boldys I, et  al. Cessation of As salivary cotinine measured by liquid chromatography/tandem alcohol consumption decreases rate of nicotine metabolism in male alco- mass spectrometry is the most accurate method for tobacco use, hol-dependent smokers. Drug Alcohol Depend. 2016;163:157–164. © The Author(s) 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. 908 For permissions, please e-mail: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ntr/article-abstract/20/7/908/4379806 by Ed 'DeepDyve' Gillespie user on 21 June 2018

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Nicotine and Tobacco ResearchOxford University Press

Published: Oct 9, 2017

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