0:00:00rows director of the centre for nicotine and smoking cessation research at duke university medical
0:00:05centre
0:00:06our mission is to better understand tobacco addiction and to develop treatments that enables smokers
0:00:12to kick their addiction to cigarettes more effectively
0:00:17current treatments unfortunately have a rather low long term success rate so nicotine patch beginning
0:00:25other forms of nicotine replacement
0:00:28generally you old about ten percent success in the long run
0:00:32the prescription a is she antics
0:00:36and side we had are approximately the same and so we've been looking at ways
0:00:42to try to increase
0:00:45the success rates with
0:00:48smoking cessation treatment using personalised an adaptive treatment approaches so personalised meeting to take their
0:00:56the treatment to the individual smoker
0:00:59based on either the genetic or other characteristics
0:01:03and then adaptive treatment which changes the treatment depending on how the smoker is responding
0:01:09in terms of inner groovy markers of
0:01:14success or failure
0:01:15i was recently at a meeting a week ago in toronto these decide for research
0:01:20on nicotine tobacco presenting the results from our latest study
0:01:25and in that study we started
0:01:28smokers who wanted to quit on a nicotine patch we take that those the patch
0:01:34depending on how heavy smoker they were so they would either where one patch giving
0:01:39standard those of twenty one milligrams nicotine today which replaces about the nicotine of that
0:01:45the cigarettes smoked daily
0:01:48but for the heavy smokers they started wearing two patches today
0:01:51now they started wearing catches even as they continue to smoke for two week period
0:01:57because in previous research we found that starting that actually for the with a
0:02:02i improves success rates smokers while smoking on the patch will reduce their smoking often
0:02:09and in previous research the people who
0:02:13spontaneously we use the smoking both do not have the best success rates when they
0:02:17reach their target state and quit smoking entirely
0:02:21so in this study we measured carbon monoxide which is an index of how much
0:02:27they're smoking after one week of wearing their nicotine patches
0:02:33for smokers whose carbon monoxide levels fell by more than fifty percent
0:02:38indicative of a substantial decrease in smoking
0:02:42we let them stay on the patch because
0:02:45they had a very good chance of succeeding in quitting smoking in fact the success
0:02:49rates were over fifty percent which is very high in this field and that was
0:02:54a that we committed weeks nineteen twelve after the rotate
0:02:58for the smokers on the other hand did not show any be reduction in the
0:03:02smoking on that first week were wearing making catches
0:03:07we randomized those smokers to run three different treatments
0:03:13one treatment was the switch them to frantically in or channel text
0:03:17the other ways to augment their the key patch with p probably a or slightly
0:03:23and the f t allows
0:03:26side and used with the couch whereas with can takes they have not to the
0:03:31combination so that's why we switch people which antics or in the case of the
0:03:37second treatment added
0:03:39so i've and on top of the patch and then the third rule
0:03:42was randomized just staying on same nicking patch treatment that they were are
0:03:49these treatments were given double blind so everybody were patches and two bills and capsules
0:03:54but in some cases they've received a active patches bills in other cases placebo
0:04:01well we found once again the
0:04:03the smokers who did not show and early response to the patch in the first
0:04:08week in terms of
0:04:10greatly reducing their smoking part accent levels if they were that's all the edge they
0:04:15had a very low success rate that's and ten percent
0:04:19however
0:04:20a for those smokers who did not respond initial patch and you were switched either
0:04:25true channel six or a received augmentation of their treatment by the addition of the
0:04:32side and they did substantially better are we rescue to speak about fifteen percent
0:04:40them we would have otherwise almost certainly fails if left on patch lighting's which to
0:04:45one of the other rescue treatment so that illustrates the adaptive nature of the treatment
0:04:50is to
0:04:52star people on the nicotine patch which is the safest most well tolerated treatment
0:04:57l along with it at the kinds of nicotine replacement and then depending on the
0:05:02early marker of smoking reduction measured by the carbon monoxide this study
0:05:08if we identify people who are almost certain to fail at that point then we
0:05:12bring in the potential recipe treatments in the form of the prescription pharmaceuticals
0:05:18a it makes sense we feel to start people and they can catch again because
0:05:23it's very safe and well tolerated and then bring in the prescription a switch while
0:05:28generally save you have are the potential of rare but serious side effects adverse reactions
0:05:34as it rescue treatment if people are not responding
0:05:38well to the nicotine
0:05:40replacement initially
0:05:42the second aspect of this study aside from adapting the treatment based on the really
0:05:47markers of a response to the nicotine patch was to try to determine whether the
0:05:54genetic nature genetic
0:05:58constitution of people would also predict
0:06:01their outcome previously with colleagues at the national institute on track of used contort will
0:06:07and colleagues we've identified genetic markers they do project
0:06:12how likely is the someone will
0:06:14six c in quitting smoking
0:06:17there were twelve thousand markers that were identified out of a billion markers on the
0:06:23you know that we examined
0:06:24in previous work
0:06:27and we used information from those twelve thousand markers to come up with a single
0:06:31score
0:06:32which we correlate with success score and this was obtained by adding up or averaging
0:06:39the favourable or unfavourable markers at each of these twelve thousand locations
0:06:44so someone of at feast favorable version of the gene more likely to predict success
0:06:50would receive a higher score than someone would have less capable of markers at these
0:06:55locations
0:06:56a that it was a single number of single score derived from these many genetic
0:07:01markers
0:07:02and we've found also the this genetic score predicted
0:07:07six that's in the study where we use the adaptive treatment change
0:07:12and the predictive nist of this score added to the productiveness their smoking reduction while
0:07:20on the patch in terms of adding more information to allow us to gain choose
0:07:26more likely to six c
0:07:27so ultimately what we hope to do is to put together the information from genetics
0:07:34other information about the person's age gender smoking habits and so forth in order to
0:07:40that we predict how likely the origins c
0:07:43but to determine whether specific treatment is more likely to work for one person that
0:07:48another
0:07:49and incorporate that into an adaptive treatment strategy that alters treatment depending on how smokers
0:07:57are responding
0:07:58we're now wanting a followup study in which one of the potential rescue treatments for
0:08:04smokers don't respond in terms of smoking reduction cash will be the combination of frantically
0:08:11and you probably a chance six and side because some work suggests that since these
0:08:17two different
0:08:18agents act by different mechanisms that adding both treatments could further enhance success rates and
0:08:25again a our strategy will be to apply that kind of
0:08:31intensive pharmacological treatment the to the people who don't respond initially in terms of the
0:08:36favourable response to take a patch so this way hopefully a step by step we
0:08:41will be developing more and more effective treatments that enable smokers to quit and remain
0:08:48abstinent because previous
0:08:50studies have shown that if a smoker does quit they will reduce the chances of
0:08:55dying from smoking related diseases from fifty percent chance smokers have about a fifty percent
0:09:02chance of dying of disease from their smoking but if they quit smoking depending on
0:09:07how
0:09:09younger role they are when they quit on average they lose about half of that
0:09:12excess risk and therefore will be more likely longer and healthier life