Abstract 14 Creating a Personalized Smoking Cessation Pharmacotherapy Program in Smokers With Crohn’s Disease Utilizing Nicotine Metabolite Ratio (NMR)

Abstract

Smoking is a well-known risk factor for disease severity and complications in Crohn’s disease (CD). Despite being identified as a quality measure, little has been studied on promoting smoking cessation in CD. We recently showed that providing nicotine replacement (NRT) in the IBD clinic was effective but limited by low rates of participation. The nicotine metabolite ratio (NMR) is a biomarker of nicotine metabolism that predicts odds of cessation and response to varenicline. The aim of this study was to evaluate the feasibility of and engagement in a personalized smoking cessation program using NMR in an IBD clinic. Daily smokers with CD (n=30) or IBD unspecified favoring CD (n=2) were recruited from a tertiary IBD clinic to participate in a pilot RCT of NMR guided vs usual care for smoking cessation. All participants were offered varenicline, bupropion, or NRT and referral to a telephone QuitLine. Medication choice in the NMR group was guided by serum NMR results. We evaluated baseline knowledge and attitudes toward smoking cessation. Tobacco habits, medication use, side effects, and clinical CD activity will be followed for 6 months. At baseline, 30 (94%) patients expressed favorable views of NMR to guide smoking cessation. Twenty-four (75%) reported knowing available cessation treatments, but only 5 (15.6%) used a medication and 3 (9.4%) a behavioral aid within 6 months. Despite having CD, only 5 (15.6%) acknowledged being at higher risk of smoking-related illness than other smokers. There were no significant differences in baseline characteristics in either group (Table 1). Medication was accepted by 30 (94%) and QuitLine referral by 28 (88%) patients. At a median 5.6 weeks (range, 4—15 weeks) follow-up, 5 (15.6%) smokers self-reported cessation. Of those who accepted medication, 21 (70%) self-reported adherence. Of those who did not report adherence, 2 patients were lost to follow-up, 2 never started treatment, 1 felt varenicline did not work, and 4 (all on varenicline) stopped because of minor side effects (nausea, agitation, and sleep disturbances). The mean cigarettes per day decreased in all participants (18.2 to 7.9, P < .001). Cigarettes per day significantly decreased in both the NMR and usual care groups, as well as in those prescribed varenicline (19.8 to 8.2, P < .001) and NRT (16.0 to 8.0, P < .01). Despite known adverse effects of smoking in CD, most patients do not utilize available cessation aids on their own. We demonstrate that cessation medications can be safely and effectively incorporated into CD care. However, higher rates of varenicline discontinuation may suggest a greater intolerance of gastrointestinal and sleep-related side effects in this population. CD patients view NMR-based treatments favorably and are an ideal target for personalized programs to improve the quality of smoking cessation care.Table 1Baseline Characteristics of Participants at EnrollmentAll (n = 32)NMR (n = 17)Usual care (n = 14)Age, mean (SD)44 (11.1)43 (10.0)45 (12.9)Male gender, n (%)15 (46.9)7 (41.2)8 (57.1)Harvey Bradshaw index, mean (SD)5.7 (5.0)4.3 (4.4)7.0 (5.3)SIBDQ, mean (SD)45.4 (13.8)47.0 (38.7)44.1 (11.8)PHQ-9, mean (SD)9.8 (10.6)9.9 (13.4)9.1 (6.7)Fast metabolizer by NMR, n (%)18 (56.3)8 (47.1)10 (71.4)Cigarettes per day, mean (SD)18.5 (9.2)17.5 (10.6)20.3 (7.3)IBD medications, n (%) 5-ASA3 (9.4)1 (5.9)2 (14.3) Immunomodulator10 (31.2)4 (23.5)6 (42.9) Anti-TNF-α21 (65.6)13 (76.5)8 (57.1) Vedolizumab5 (15.6)3 (17.6)2 (14.3) Ustekinumab1 (3.1)0 (0)1 (7.1) Prednisone4 (12.5)2 (11.8)2 (14.3)Study medication prescribed, n (%) Varenicline16 (50.0)7 (41.2)9 (64.3) Bupropion3 (9.4)1 (5.9)2 (14.3) Nicotine replacement therapy11 (34.3)8 (47.1)3 (21.4)NOTE. No differences between NMR and usual care groups met significance of P < .05. One patient was not randomized because of laboratory error.SIBDQ, Short IBD Questionnaire; PHQ-9, Patient Health Questionnaire-9. Open table in a new tab