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• Parts of feline immunodeficiency virus (FIV) isolated from wild lions have undergone substantial genetic recombination, says research published in the online open access journal BMC Genomics. The sequencing of the two full FIV genomes of different lion subtypes shows the importance of whole-genome analysis in understanding complex genetic events.
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• Starting nicotine replacement therapy (NRT) as a transdermal patch before the target quit date doubles success rates according to a meta-analysis, although only four studies of varied design were eligible for analysis. The authors of the analysis note that starting NRT before the quit date might improve smoking cessation rates by acclimatising users and separating nicotine intake from smoking. This approach has been most studied using transdermal patches, however trials have varied in size and duration. The aim of this analysis was to determine from the trial data whether a clear benefit had been shown. The authors searched for randomised controlled trials in which the effects of pre-quit treatment were compared directly with treatment starting on the target quit day. Eligible studies recruited smokers who were interested in quitting (rather than reduction), where all participants received NRT from the target quit date, where participants were randomised to receive pre-quit NRT or control (placebo or no NRT), and where cessation was verified 4 to 6 weeks later by biochemical analysis. Primary end-point for the analysis was continuous abstinence for at least 28 days assessed at 6 weeks following quit day, or the nearest reported outcome where this was not available; outcomes at six months were examined as secondary endpoints. Four trials (n=755) were available and eligible for analysis, all involving nicotine patches: two trials involving nicotine gum were also located, however one was ineligible as a different pre-quit dose was used, and the second had not yet completed. The trials had different designs and durations, and two (n=176) also included treatment with mecamylamine (a nicotinic antagonist). Three studies originated from the same research team. Analysis found that pre-quit treatment approximately doubled the quit rate at six weeks compared to starting NRT on the quit day (odds ratio 1.91; 95% CI, 1.31 to 2.93). A similar pattern was seen with results at six months (OR 2.17; 95% CI, 1.46 to 3.22). Co-administration of mecamylamine seemed to make no significant difference to the results. There was no evidence that one study was significantly influencing the pooled result - exclusion of each from analysis made little difference to the overall result. Based on their analysis, the authors conclude that starting NRT patch therapy before the target quit date roughly doubles the chance of success, both in the short-term and up to six months. Although the studies differed widely in their design, the authors consider that the analysis suggests a consistent effect. They note that where the information was collected, there was spontaneous pre-quit reduction in smoking by subjects in the pre-quit group although none were instructed to do this. They discuss possible mechanisms for the effect including pharmacodynamic effects, effects on learned associations involved in smoking, and on extinction of smoking reinforcement. [Editor's comment: an interesting analysis that appears to have been carefully done, but some cautions remain: the number of participants was relatively small, and it is a slight concern that most of the data came from one research team. This technique would not be covered by current NICE guidance on smoking cessation, and it is uncertain whether it would fit with the current product licences for NRT patches.]
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