Varenicline leads in helping smokers kick the habit, study

TOP LINE:

Most smokers successfully quit after their first attempt. Switching patients from nicotine replacement therapy such as the patch and lozenge to varenicline and increasing the dosage helped more people achieve cigarette abstinence, a new study shows.

METHODOLOGY:

• The double-blind, placebo-controlled, randomized trial included 490 participants who took 2 mg of varenicline or used a 21 mg nicotine patch and a 2 mg lozenge for the first six weeks after their first attempt to quit smoking.
• Participants who failed to abstain from cigarette smoking after the initial period were re-randomized to continue the same treatment, change therapy, or increase dosages to ≥ 3 mg Varenicline or a 42 mg patch and lozenge for another 6 weeks.
• Starting in 2015, data were analyzed over a four-year period from adults up to age 75 who smoked an average of 20 cigarettes per day and had no unstable psychiatric disorders.
• At the end of the initial treatment, the varenicline group consisted of 157 people who failed to quit smoking and 191 people who failed in the nicotine replacement therapy group.

TAKEAWAY:

• After the initial intervention period, the prescribed drug was found to be more effective in smoking cessation: 22% of those receiving combined nicotine replacement therapy (CNRT) abstained from smoking (95% credible interval (Crl), 12%-27%) and 36% abstained in the varenicline group (95% CrI, 30%-42%).
• Of those who did not achieve abstinence after six weeks of nicotine replacement therapy (NRT), 14% eventually quit after another six weeks of switching to varenicline; 14% achieved success after increasing the dose of NRT patches; and 8% were successful and continued their original NRT dosing.
• Of the people who originally took varenicline and had no success quitting, 32% were assigned to increase their dosage to ≥ 3 mg, and one-fifth of these people were able to quit after the second intervention period; only 3% were successful if they continued on their original dosing, and no participants achieved abstinence who switched to NRT.
• Increasing the Varenicline dose had an absolute risk difference of 18% (95% CrI, 13%-24%).

IN PRACTICE:

“For individuals who smoked but did not achieve abstinence after treatment with Varenicline, increasing dosage increased abstinence versus continuing, while for non-abstinents initially treated with CNRT, a dose increase or switch to Varenicline may enhance abstinence and provide viable rescue strategies. are,” the study said. authors wrote.

SOURCE:

The study was led by Paul M. Cincipinini, PhD, and colleagues from the Department of Behavioral Sciences at the University of Texas MD Anderson Cancer Center, Houston, and published in JAMA.

LIMITS:

Participants who did not abstain in the first phase and did not return were re-randomized to the same dosing group, reducing the degree of randomization. The use of 2 mg lozenges instead of 4 mg may have limited the effectiveness of the CNRT in heavier smokers. Some interventions were off-label, including increasing the varenicline dose to 3 mg.

DISCLOSURE:

Several authors reported receiving grants and compensation in addition to their submitted work. No other revelations have been reported. The study was supported by a grant from the Cancer Prevention and Research Institute of Texas, the University of Texas MD Anderson Lung Cancer Moon Shot Program and the Permanent Health Funds of the State of Texas. Varenicline was supplied by Pfizer Pharmaceuticals.