We would like to thank Dr Braillon for his letter1 about our study investigating the relative effectiveness of varenicline and nicotine replacement therapy (NRT) using electronic medical records in the Clinical Practice Research Datalink (CPRD).2 We agree that the CPRD is an abundant resource. About 12% of GP practices in England are currently participating in CPRD Gold.3,4 National Institute for Clinical Excellence guidelines state that combination-NRT should be prescribed to patients who show a high level of dependence on nicotine or who have found single forms of NRT inadequate in the past.5 In our study, 23% of patients received more than one prescription for NRT.2 Previous research using data from the NHS Stop Smoking Services has found that varenicline is marginally more effective than combination NRT at 4-week follow-up[odds ratio, 1.08; 95% confidence interval (CI), 1.00 to 1.16].6 A Cochrane review pooled effect estimates from seven randomized controlled trials comparing combination- with single-NRT, and found that combination-NRT was more effective (risk ratio, 1.35; 95% CI, 1.11 to 1.63).7 Programmes of behavioural support for people using smoking cessation medication increase the chances of quitting (risk ratio, 1.25; 95% CI, 1.08 to 1.45).8 However, an English survey of smokers conducted between 2006 and 2012 found that only 4.8% of people attempting to quit smoking had used both prescription pharmacotherapy and specialist behavioural support.9 In our study, it is possible that behavioural support was available to patients through primary care-based stop-smoking services, which are predominantly led by practice nurses or smoking cessation advisers. However, our data did not contain information on whether patients accessed behavioural support. Referral to and attendance at smoking cessation behavioural support is not routinely recorded by GPs. Conflict of interest: We work with researchers funded by Global Research Awards for Nicotine Dependence (GRAND), which is an Independent Competitive Grants Program supported by Pfizer, the manufacturer of varenicline. References 1 Braillon . Long-term smoking cessation: from general practice to public health . Int J Epidemiol 2018 . 2 Taylor GMJ , Taylor AE , Thomas KH et al. The effectiveness of varenicline versus nicotine replacement therapy on long-term smoking cessation in primary care: a prospective cohort study of electronic medical records . Int J Epidemiol 2017 ; 46 : 1948 – 57 . Google Scholar CrossRef Search ADS PubMed 3 Campbell J , Dedman D , Eaton SC , Gallagher AWT. Is the CPRD GOLD population comparable to the U.K. population? Pharmacoepidemiol Drug Saf 2013 ; 22 : 280 . 4 Herrett E , Gallagher AM , Bhaskaran K et al. Data resource profile: Clinical Practice Research Datalink (CPRD) . Int J Epidemiol 2015 ; 44 : 827 – 36 . Google Scholar CrossRef Search ADS PubMed 5 NICE . Public Health Guideline [PH10] Stop Smoking Services. 2013 . https://www.nice.org.uk/guidance/ph10. 6 Brose LS , West R , Stapleton JA. Comparison of the effectiveness of varenicline and combination nicotine replacement therapy for smoking cessation in clinical practice . Mayo Clinic Proc 2013 ; 88 : 226 – 33 . Google Scholar CrossRef Search ADS 7 Stead LF , Perera R , Bullen C , Mant D , Hartmann-Boyce J , Cahill K , Lancaster T. Nicotine replacement therapy for smoking cessation . Cochrane Database Syst Rev 2012 ; 11 : CD000146 . Google Scholar PubMed 8 Stead LF , Koilpillai P , Lancaster T. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation . Cochrane Database Syst Rev 2015 ; 10 : CD009670 . 9 Kotz D , Brown J , West R. Prospective cohort study of the effectiveness of smoking cessation treatments used in the “Real World” . Mayo Clin Proc 2014 ; 89 : 1360 – 67 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
International Journal of Epidemiology – Oxford University Press
Published: May 9, 2018
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