(Philadelphia, PA) – A blood test may enable
doctors to predict which smokers using the nicotine patch are likely
to experience the least amount of cravings and have the highest
probability of success in quitting cigarettes, according to the
results of a study in the June issue of the Journal of Clinical
Pharmacology and Therapeutics.
The blood test, which is a measure of the rate at which nicotine
is metabolized, may eventually be performed non-invasively using
saliva or urine samples. “The ultimate aim here is to distinguish
smokers who are likely to benefit from a standard dose of nicotine
patch from those who may need a higher dose patch or an alternative
therapy in order to succeed in quitting,” said lead researcher
for the study, Caryn Lerman, PhD, Associate Director
for Cancer Control and Population Science at the Abramson
Cancer Center of the University of Pennsylvania, and Director
of the University of Pennsylvania Transdisciplinary Tobacco Use
When nicotine is metabolized – or broken down in the body
– it turns to cotinine. Cotinine is then metabolized to 3-hydroxycotinine
(3-HC) by an enzyme in the liver. This study measured the ratio
of these two breakdown products of nicotine among 480 smokers. A
high ratio meant rapid metabolism of nicotine, which was associated
with higher amounts of craving and greater difficulty in quitting
cigarettes using the nicotine patch.
The smokers who participated in the study quit smoking and started
using either the patch or the nicotine nasal spray for eight weeks.
Measurements of carbon monoxide levels in exhaled air identified
those who were not smoking at the eight-week and six-month intervals
following the quit date. Study participants also provided information
on level of cravings for cigarettes one week after their quit date.
“Using the rate of nicotine metabolism, we were able to predict
the level of cravings and the efficacy of the nicotine patch,”
said Lerman. “Similar results could not be obtained for the
nicotine spray, most likely because the subjects were able to compensate
for rapid metabolism of nicotine by using the spray more often.”
“If a prospective study replicates these results, we will
be in a position to recommend this blood test to tailor the type
and dose of nicotine replacement therapy for smokers who wish to
quit,” Lerman said.
This study was funded by the National Cancer Institute, the National
Institute on Drug Abuse, and the Pennsylvania State Tobacco Settlement.
The Robert Wood Johnson Foundation has also supported the University
of Pennsylvania’s Transdisciplinary Tobacco Use Research Center,
which conducted this research.
The paper based on this study is scheduled for the June issue of
the Journal of Clinical Pharmacology and Therapeutics.
It has been posted on the web for subscribers.
The Abramson Cancer Center of the University of Pennsylvania
was established in 1973 as a center of excellence in cancer
research, patient care, education and outreach. Today, the Abramson
Cancer Center ranks as one of the nation’s best in cancer
care, according to US News and World Report, and is one of the top
five in National Cancer Institute (NCI) funding. It is one of only
39 NCI-designated comprehensive cancer centers in the United States.
Home to one of the largest clinical and research programs in the
world, the Abramson Cancer Center of the University of Pennsylvania
has 275 active cancer researchers and 250 Penn physicians involved
in cancer prevention, diagnosis and treatment. More information
about the Abramson Cancer Center is available at: www.pennhealth.com/cancer.
The Abramson Family Cancer Research Institute serves
as the forum for integrating cancer research, education, and patient
care at the Abramson Cancer Center at the University of Pennsylvania.
The Institute supports innovative cancer research, leading-edge
care that is delivered in a compassionate manner, and the education
of professionals who share a commitment to innovative cancer research.
The Institute has set a new national standard for interdisciplinary
cancer research and treatment, and is creating knowledge that will
offer even greater hope for cancer patients and their loved ones.
PENN Medicine is a $2.9 billion enterprise
dedicated to the related missions of medical education, biomedical
research, and high-quality patient care. PENN Medicine consists
of the University of Pennsylvania School of Medicine (founded in
1765 as the nation's first medical school) and the University of
Pennsylvania Health System.
Penn's School of Medicine is ranked #2 in the nation for receipt
of NIH research funds; and ranked #3 in the nation in U.S.News &
World Report's most recent ranking of top research-oriented medical
schools. Supporting 1,400 fulltime faculty and 700 students, the
School of Medicine is recognized worldwide for its superior education
and training of the next generation of physician-scientists and
leaders of academic medicine.
The University of Pennsylvania Health System includes three
hospitals [Hospital of the University of Pennsylvania, which is
consistently ranked one of the nation's few "Honor Roll"
hospitals by U.S.News & World Report; Pennsylvania Hospital,
the nation's first hospital; and Penn Presbyterian Medical Center];
a faculty practice plan; a primary-care provider network; two multispecialty
satellite facilities; and home care and hospice.