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Māori and Pacific focus for quit smoking research

Māori and Pacific focus for quit smoking research
Media Release - University of Auckland - 20 June 2016

Two research studies aimed at the goal of reduced smoking among New Zealanders to five percent or less by 2025, will go ahead at the University of Auckland this year.

A unique head to head trial that will compare the effective use of two quit smoking aids, Cytisine and Varenicline, will involve more than 2000 Māori participants from the Lakes District Health Board region.

The second study is smaller with 262 participants from the Auckland region who suffer from a lung condition called Chronic Obstructive Pulmonary Disease or COPD.

The research projects were funded for a total of just under $2.8 million by the Health Research Council NZ (HRC) and are led by Associate Professor Natalie Walker from the University’s National Institute of Health Innovation.

“The Cytisine study focusses on Māori because the rate of smoking is so high in this group and so they potentially have the most to gain from help to quit smoking, says Dr Walker.

“We want to find out if the proportion of people who successfully stop smoking after taking Cytisine is similar to those taking Varenicline,. If cytisine is effective, has an acceptable safety profile, and is cost-effective, it has substantial potential for use as an alternative treatment to help people quit smoking.”

“Cytisine is the cheaper option for a quit medication and is found in a native plant (kowhai), so although we don’t source it from there, it may be more acceptable to Māori,” she says. “Our team wants to find out if Cytisine is acceptable, reliable, effective and safe in this population.”

The study team includes Dr Barry Smith (Te Rarawa and Ngati Kahu) and will include a kaitiaki advisory group for the team to consult during the research.

Last year, this research group published in the New England Journal of Medicine, the world’s first trial comparing Cytisine to nicotine replacement therapy (NRT).

The HRC-funded study found that 40 percent using Cytisine were still not smoking after one month, compared 31 percent with NRT. Cytisine was also more effective than NRT at one week, two months and six months.

Those results, the lower costs of Cytisine, and the conclusion that it is ‘more clinically effective and cost effective than varenicline’ lead to the need for a head-to-head trial.

Of the COPD project, ‘Smoking relapse prevention in COPD patients’, Dr Walker says Māori and Pacific people are a priority group for quit smoking outreach.

“The leading risk factor for COPD, and the easiest one to modify, is exposure to tobacco smoke - about 90 percent of those dying from COPD have a history of cigarette smoking.”

“If COPD is identified early enough and people stop smoking early enough and stay quit, there is an opportunity to prolong their life and improve their quality of life,” she says. “We need to keep them on a longer term treatment plan and help them to not relapse back into smoking.”

The study will determine whether recent ex-smokers with COPD who successfully stop smoking after taking Varenicline are less likely to relapse back to smoking if they continue using Varenicline for a further 12 weeks.

“COPD is a common, treatable and preventable disease with persistent airflow limitation that is usually progressive,” says Dr Walker. “Patients with COPD may have symptoms of shortness of breath, cough or fatigue and reduced effort tolerance which worsen as the disease progresses.”

COPD is the fifth leading cause of death in high income countries, the only one increasing in incidence, and is expected to become the third leading cause of death by 2030, after heart disease and cancer.

In 2006/7 the New Zealand Health Survey reported the age-standardized prevalence of COPD was 6.6 percent (higher in women) and in 2010/11 it was estimated that more than 138,000 New Zealanders over 35 years had COPD.

“The prevalence of COPD increases with age and is higher in Māori than non-Māori,” says Dr Walker. “Māori are five times more likely to die from COPD than non-Māori and develop the condition 20 years earlier.”

“The costs of COPD are high to both individual patients and health care systems and increase with the severity of the disease”, she says.


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