1. An update on helping patients to quit smoking Henri-Jean Aubin University Paris-Sud, Paris, France

2. Disclosures InterestName of organization Grant Support ANR Research Support INSERM, ANR, AP-HP Honoraria and Consultancy Lundbeck, D&A Pharma, Ethypharm, Merck, Pfizer Speakers Bureau Lundbeck, D&A Pharma, Pfizer Scientific Advisory Board Lundbeck, D&A Pharma, Ethypharm, Pfizer

3. Kaplan-Meier curve of time to relapse Yeomans, et al. 2011. Int J Clin Pract

4. Success rates with placebo Moore RA, Aubin HJ. Do placebo response rates from cessation trials inform on strength of addictions? Int J Environ Res Public Health. Jan 2012;9(1):192-211.

5. Benowitz, N. L. (2010) N Engl J Med

6. Polosa & Benowitz Trends Pharmacol Sci. 2011

9. Effectiveness of monotherapies Adapted from Treating Tobacco Use and Dependence. 2008 Update. Clinical Practice Guideline. (Fiore et al., 2008)

10. Effectiveness of combination therapies Adapted from Treating Tobacco Use and Dependence. 2008 Update. Clinical Practice Guideline. (Fiore et al., 2008)

11. Curent contreversies Varenicline safetyHarm reducionE-cigarettes

12. Curent contreversies Varenicline safetyHarm reducionE-cigarettes

13. Moore TJ, Furberg CD, Glenmullen J, Maltsberger JT, Singh S. Plos one. 2011;6(11):e27016.

14. Mettre image sur presse chantix suicide

15. Suicide fumeurs actuels vs jamais fumeurs Li, et al. J Psychiatr Res. 2012

16. Suicide anciens fumeurs vs jamais fumeurs Li, et al. J Psychiatr Res. 2012

17. Suicide Intensité du tabagisme Li, et al. J Psychiatr Res. 2012

18. Bruijnzeel AW. Tobacco addiction and the dysregulation of brain stress systems. Neurosci Biobehav Rev 2012

19. Anthenelli et al. Ann Intern Med 2013;159(6):390-400.

21. Efficacy Anthenelli et al. Ann Intern Med 2013;159(6):390-400.

22. MADRS scores mean change from baseline Anthenelli et al. Ann Intern Med 2013;159(6):390-400.

23. MADRS scores mean change from baseline Anthenelli et al. Ann Intern Med 2013;159(6):390-400.

24. HAM-A scores mean change from baseline Anthenelli et al. Ann Intern Med 2013;159(6):390-400.

25. Psychiatric adverse events Anthenelli et al. Ann Intern Med 2013;159(6):390-400.

26. Participants with positive responses at the Columbia Suicide Severity rating Scale Anthenelli et al. Ann Intern Med 2013;159(6):390-400.

27. Suicidalité Idées ou comportement suicidairevareniclineplacebo Vie entière Nombre de patients évalués, N 256269 Idées ou comportement suicidaire, n (%) 88 (34,4)89 (33,1) Visite initiale Nombre de patients évalués, N 256269 Idées ou comportement suicidaire, n (%) 6 (2,3)1 (0,4) Phase de traitement Nombre de patients évalués, N 251268 Idées ou comportement suicidaire, n (%) 15 (6)20 (7,5) Phase de suivi sans traitement Nombre de patients évalués, N 209207 Idées ou comportement suicidaire, n (%) 13 (6,6)12 (5,8) Anthenelli et al. Ann Intern Med 2013;159(6):390-400.

28. Thomas et al. BMJ 2013;347:f5704..

29. Methods Thomas et al. BMJ 2013;347:f5704.. Prospective cohort study within the Clinical Practice Research Datalink. Design 349 general practices in England. Setting 119 546 men and women aged 18 years and over who used a smoking cessation product between 1 September 2006 and 31 October 2011. Participants 81 545 users of nicotine replacement products (68.2%) 6741 bupropion (5.6%) 31 260 varenicline (26.2%) Treatments

30. Thomas et al. BMJ 2013;347:f5704..

35. Curent contreversies Varenicline safetyHarm reducionE-cigarettes

36. Curent contreversies Varenicline safetyHarm reducionE-cigarettes

37. Low risk drinking

38. Rehm et al. Alcohol Res Health 2003;27(1):39–51 J-shaped relationship between alcohol consumption and coronary heart disease Relative risk 0.6 1.6 1.4 1.2 1.0 0.8 Alcohol (g/day) 20 g/day 025507510 0 12 5 15 0 72 g/day 89 g/day

39. Correlation between alcohol consumption and mortality Rehm et al. Addiction 2011;106(Suppl 1):11–19 020406080100 18 12 4 0 Risk of death (%) 16 8 10 2 14 6 Alcohol consumption (g/day) Men Women 39

40. Correlation between alcohol consumption and mortality Rehm et al. Addiction 2011;106(Suppl 1):11–19 020406080100 18 12 4 0 Risk of death (%) 16 8 10 2 14 6 Alcohol consumption (g/day) Men Women 40 Difference between 11 & 14 drinks per day has an effect on mortality risk about 10 times as much as the difference between 0 & 3 drinks/day

41. No low risk smoking Photos: Colourbox.com 41

42. Relationship between ischaemic heart disease and tobacco exposure Smith et al. Toxicol Sci 2000;54(2):462–472 Relative risk of ischaemic heart disease Cigarettes/‘cigarette equivalents’ per day 3.0 2.5 2.0 1.5 1.0 0.5 0.0 -50510152025 1.39 1.3 1.0 1.78 42

43. Relationship between lung cancer and cigarettes per day Lubin et al. Cancer Epidemiol Biomarkers Prev 2006;15:517–523 43 0.5 0.4 0.3 0.2 0.1 0.5 010203040506070 Cigarettes smoked per day Excess odds ratio (OR) per pack-year

44. Relationship between lung cancer and duration of exposure Lubin et al. Cancer Epidemiol Biomarkers Prev 2006;15:517–523 N.S.=never smoked

45. Curent contreversies Varenicline safetyHarm reducionE-cigarettes

46. Curent contreversies Varenicline safetyHarm reducionE-cigarettes