A study in The Lancet Respiratory Medicine suggests that the rate at which smokers metabolize nicotine could be a significant factor in guiding smoking cessation treatment. In smokers with normal metabolism of nicotine, nicotine levels drop more quickly; these individuals are likely to smoke more and have greater difficulty in quitting. The nicotine metabolite ratio (NMR) has previously been identified to assess environmental and genetic effects on nicotine metabolism, but this is the first study to utilize NMR status on the optimization of smoking cessation treatments.

In this research, 1,246 smokers (662 slow metabolizers of nicotine and 584 normal metabolizers of nicotine) were randomly assigned to 11 weeks of either a nicotine patch plus placebo pill, varenicline plus placebo patch, or a placebo pill and patch; all patients received behavioral counseling and were followed for 12 months after their quit date.

Normal metabolizers taking varenicline were approximately twice as likely not to smoke as those using the nicotine patch at the end of the 11 weeks and were significantly more likely to still be abstaining from smoking six months later. Varenicline was as effective as nicotine patches for smoking cessation in slow metabolizers, although a greater number of overall side effects were reported with varenicline.

A point-of-care blood test to measure the rate at which nicotine is metabolized in a patient could be developed and implemented into clinical practice for optimal smoking cessation treatment, stated study co-lead author Rachel Tyndale, PhD.

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