1356 International Journal of Epidemiology, 2018, Vol. 47, No. 4 International Journal of Epidemiology, 2018, 1356 Response to: Long-term smoking doi: 10.1093/ije/dyy084 Advance Access Publication Date: 9 May 2018 cessation: from general practice to public health Gemma MJ Taylor and Neil M Davies* Medical Research Council Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK *Corresponding author. Medical Research Council Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Oakﬁeld House, Oakﬁeld Grove, Bristol BS8 2BN, UK. E-mail: Neil.Davies@bristol.ac.uk We would like to thank Dr Braillon for his letter about to and attendance at smoking cessation behavioural sup- our study investigating the relative effectiveness of port is not routinely recorded by GPs. varenicline and nicotine replacement therapy (NRT) using Conflict of interest: We work with researchers funded electronic medical records in the Clinical Practice Research by Global Research Awards for Nicotine Dependence Datalink (CPRD). We agree that the CPRD is an abun- (GRAND), which is an Independent Competitive Grants dant resource. About 12% of GP practices in England are Program supported by Pfizer, the manufacturer of 3,4 currently participating in CPRD Gold. varenicline. National Institute for Clinical Excellence guidelines state References that combination-NRT should be prescribed to patients who show a high level of dependence on nicotine or who have 1. Braillon A. Long-term smoking cessation: from general practice to found single forms of NRT inadequate in the past. In our public health. Int J Epidemiol 2018;47:1355. 2. Taylor GMJ, Taylor AE, Thomas KH et al. The effectiveness of study, 23% of patients received more than one prescription varenicline versus nicotine replacement therapy on long-term for NRT. Previous research using data from the NHS Stop smoking cessation in primary care: a prospective cohort study of Smoking Services has found that varenicline is marginally electronic medical records. Int J Epidemiol 2017;46:1948–57. more effective than combination NRT at 4-week follow- 3. Campbell J, Dedman D, Eaton SC, Gallagher AWT. Is the CPRD up[odds ratio, 1.08; 95% confidence interval (CI), 1.00 to GOLD population comparable to the U.K. population? Pharma- 1.16]. A Cochrane review pooled effect estimates from coepidemiol Drug Saf 2013;22:280. seven randomized controlled trials comparing combination- 4. Herrett E, Gallagher AM, Bhaskaran K et al. Data resource pro- ﬁle: Clinical Practice Research Datalink (CPRD). Int J Epidemiol with single-NRT, and found that combination-NRT was 2015;44:827–36. more effective (risk ratio, 1.35; 95% CI, 1.11 to 1.63). 5. NICE. Public Health Guideline [PH10] Stop Smoking Services. Programmes of behavioural support for people using 2013. https://www.nice.org.uk/guidance/ph10. smoking cessation medication increase the chances of quit- 6. Brose LS, West R, Stapleton JA. Comparison of the effectiveness of ting (risk ratio, 1.25; 95% CI, 1.08 to 1.45). However, an varenicline and combination nicotine replacement therapy for smok- English survey of smokers conducted between 2006 and ing cessation in clinical practice. Mayo Clinic Proc 2013;88:226–33. 2012 found that only 4.8% of people attempting to quit 7. Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, Lancaster T. Nicotine replacement therapy for smoking cessa- smoking had used both prescription pharmacotherapy and tion. Cochrane Database Syst Rev 2012;11:CD000146. specialist behavioural support. In our study, it is possible 8. Stead LF, Koilpillai P, Lancaster T. Additional behavioural sup- that behavioural support was available to patients through port as an adjunct to pharmacotherapy for smoking cessation. primary care-based stop-smoking services, which are pre- Cochrane Database Syst Rev 2015;10:CD009670. dominantly led by practice nurses or smoking cessation 9. Kotz D, Brown J, West R. Prospective cohort study of the effec- advisers. However, our data did not contain information tiveness of smoking cessation treatments used in the “Real on whether patients accessed behavioural support. Referral World”. Mayo Clin Proc 2014;89:1360–67. V The Author 2018; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association
International Journal of Epidemiology – Oxford University Press
Published: Aug 1, 2018
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