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  1. Candy Lee
  1. Correspondence to Dr Candy Lee, ST7 Specialty Trainee in Respiratory Medicine and General Internal Medicine, Abertawe Bro Morgannwg University Health Board, Singleton Hospital, Sketty Lane, Swansea SA2 8QA, UK; clee128{at}doctors.org.uk

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Aid to select smoking cessation treatment?

Measuring a biomarker of nicotine clearance may improve smoking quit rate success by optimising cessation treatment selection according to this multicentred, double-blinded, randomised control trial (Lancet Respir Med 2015;doi:10.1016/S2213-2600(14)70294-2). Nicotine metabolite ratio was measured in 1246 patients who were randomly assigned to one of three treatments (nicotine patch plus placebo pill, varenicline plus placebo patch or placebo patch and pill). Patients were assessed at the end of 11-week treatment and had follow-up at 6 and 12 months. Normal metabolisers of nicotine were found to have significantly higher quit rates with varenicline than with nicotine patch at the end of treatment (38.5% vs 22.5%) and at 6 months (22% vs 13.6%), but this difference was no longer significant at 12-month follow-up. There was no significant difference in the efficacy of both treatments for slow metabolisers but more severe side effects were reported when taking varenicline, suggesting that nicotine patches may be a better treatment choice for this patient group. Further research is required to confirm results and viability of use in clinical practice.

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