Efficacy of Varenicline Combined With Nicotine Replacement Therapy vs Varenicline Alone for Smoking Cessation

Koegelenberg, Coenraad F. N.; Noor, Firdows; Bateman, Eric D.; Zyl-Smit, Richard van; Bruning, Axel; O’Brien, John A.; Smith, C.Douglas; Abdool-Gaffar, Mohamed Sabeer; Emanuel, S; Esterhuizen, Tonya; Irusen, Elvis

doi:10.1001/jama.2014.7195

Cited by 143 publications

(110 citation statements)

References 17 publications

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“…This is also consistent with results suggested by Tonnesen where a 1-year abstinence rate of 25% should be expected from a smoking cessation programme 6 . While most of the studies showed a decrease in abstinence rate over time [11][12][13][14][15] , our study demonstrated a significant increase (P<0.05) in abstinence rate from clinic completion (19.8%) to both 6-(23.8%) and 12-month (25.4%) followup. This is consistent with the results found by Philbrick and colleagues who reported an increase in abstinence rate from 47.6% to 52.4% at 3 and 6 months respectively 16 and also the pilot study performed in CGH previously 7 .…”

Section: Discussioncontrasting

confidence: 65%

A 4-year Follow-up Evaluation Of A Pharmacist-managed Smoking Cessation Programme With Emphasis On Effectiveness Of Different Treatment Modalities

Poh¹,

Ng²

2016

Tob. Prev. Cessation

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INTRODUCTION Smoking cessation clinic (SCC) was introduced into Singapore's healthcare setting to combat the increase in smoking prevalence. This study aims to determine (1)the effectiveness of a pharmacist-managed SCC, and (2)the association between abstinence rates and different treatment modalities, in Changi General Hospital. METHODS 445 patients who had attended the SCC were retrospectively reviewed. These patients received structured smoking cessation counselling with or without additional cessation aid comprising of nicotine replacement therapy (NRT), varenicline or bupropion. The study end points were point-prevalence abstinence rates (1)for all subjects, and (2)associated with various treatment modalities, at the final SCC review, 6-and 12-month follow-up. RESULTS The point-prevalence abstinence rates for all patients at completion of SCC review, 6-and 12-month follow-up were 19.8%, 23.8% (p=0.033), and 25.4% (p=0.009), respectively. Abstinence rates between 6-and 12-month follow-up were not statistically different. A significant association between abstinence rates and the use of pharmacotherapy was detected at 6-months' follow-up (p=0.005), but not at SCC review completion or 12-months' follow-up (p>0.05). Abstinence rates were highest at 6-and 12-month with use of varenicline (37.4% and 34.3%, respectively) followed by combination NRT (21.7% and 26.1%). Furthermore, patients who had received only smoking cessation counselling had abstinence rates of 20.7% and 26.0% at 6-and 12-month follow-up. CONCLUSIONS Patient participation in a pharmacist-managed SCC was associated with significantly improved abstinence rates at 6-and 12-months following programme completion. The use of pharmacotherapy was significantly associated with overall abstinence rates at 6-months' followup with varenicline appearing as the most effective smoking cessation aid.

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Section: Discussioncontrasting

confidence: 65%

A 4-year Follow-up Evaluation Of A Pharmacist-managed Smoking Cessation Programme With Emphasis On Effectiveness Of Different Treatment Modalities

Poh¹,

Ng²

2016

Tob. Prev. Cessation

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“…52 A third study compared varenicline plus nicotine replacement therapy (patch) to placebo and observed abstinence rates of 55% versus 41% at 12 weeks. 53 One must keep in mind that even though our placebo group had higher abstinence rates this is a limited comparison given the different populations. Our participants were postpartum and other factors could play a role such as new mothers and more concern about passive smoke and influence of breastfeeding.…”

Section: Discussionmentioning

confidence: 95%

Progesterone and Postpartum Smoking Relapse: A Pilot Double-Blind Placebo-Controlled Randomized Trial

Allen

Lunos

et al. 2016

NICTOB

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Introduction: Pregnancy is a strong motivator to quit smoking, yet postpartum relapse rates are high. Growing evidence suggests a role of sex hormones in drug abuse behavior and given the precipitous drop in sex hormones at delivery, they may play a role in postpartum relapse. This pilot study evaluates the feasibility and potential role of exogenous progesterone in postpartum smoking relapse. Methods: This 12-week double-blind placebo-controlled randomized pilot trial randomized 46 abstinent postpartum women to active progesterone (PRO; 200 mg twice a day) versus placebo (PBO) for 4 weeks. Participants were followed for relapse for 12 weeks. Main study outcomes include abstinence (point prevalence), feasibility (compliance per number of clinic visits attended, pill counts and Electronic Data Capture [EDC] completed) and self-reported acceptability. Safety was also measured by depressive symptom scores, adverse events, and breastfeeding. Results: Overall retention rate was 87% at week 12. At week 4, abstinence rates were 75% in the PRO group and 68.2% in the PBO group (p = .75). Medication adherence was 68% and clinic visit attendance was 80%, with no differences by randomization. Depressive symptom scores, adverse events, and breastfeeding did not vary by randomization. Conclusions: Although the study was not powered to evaluate abstinence rates, we did observe a higher prevalence of abstinence at week 4 in the PRO group. Further, exogenous progesterone was well tolerated and did not adversely affect depressive symptoms or breastfeeding. Thus, the results of this pilot study indicate further investigation into progesterone as a postpartum relapse prevention strategy is warranted. Implications: This innovative pilot trial determined the feasibility of delivering exogenous progesterone as a potential prevention of postpartum smoking relapse. We observed high retention and moderate adherence rates, as well as high acceptability among participants. Further, though not statistically significant, more women in the treatment group remained abstinent from smoking during follow-up. This project adds to the growing body of literature on the role of sex hormones in smoking relapse and also provides support for a fully powered clinical trial.

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“…12 13 It continues to attract attention from researchers and practitioners alike. [14][15][16][17][18][19] Several studies have investigated how much the introduction of varenicline has led to an increase in the overall use of pharmacotherapy. These studies differ in sample size and in methodology.…”

Section: Introductionmentioning

confidence: 99%

Quitting smoking before and after varenicline: a population study based on two representative samples of US smokers

et al. 2015

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Background Varenicline is known to have greater efficacy than other pharmacotherapy for treating nicotine dependence and has gained popularity since its introduction in 2006. This study examines if adding varenicline to existing pharmacotherapies increased the population cessation rate. Methods Data are from two cross-sectional U.S. Current Population Surveys—Tobacco Use Supplements (2003 and 2010–2011). Smokers and recent quitters 18 or older (N=34,869 in 2003, N=27,751 in 2010–2011) were asked if they had used varenicline, bupropion or nicotine replacement therapies (NRT) in their most recent quit attempt. The annual cessation rate, the percent of smokers who were quit for ≥ 3 months, was compared between surveys. Results Varenicline use increased from 0% in 2003 to 10.9% in 2010–2011, while use of bupropion decreased from 9.1% to 3.5%, and NRT from 24.5% to 22.4%. Use of any pharmacotherapy increased 2.4 percentage points. Varenicline users stayed on cessation aids longer and were less likely to relapse than users of other pharmacotherapies in the first three months of a quit attempt, after which the difference was no longer significant. The change in annual cessation rate was negligible, from 4.5% in 2003 to 4.7% in 2010–2011 (P=0.36). Conclusion Addition of varenicline to the list of approved cessation aids has mainly led to displacement of other therapies. As a result, there was no meaningful change in population cessation rate despite a remarkable increase in varenicline use. The population impact of a new therapy is a function of more than efficacy or reach of the therapy.

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Efficacy of Varenicline Combined With Nicotine Replacement Therapy vs Varenicline Alone for Smoking Cessation

Abstract: clinicaltrials.gov Identifier: NCT01444131.

Cited by 143 publications

References 17 publications

A 4-year Follow-up Evaluation Of A Pharmacist-managed Smoking Cessation Programme With Emphasis On Effectiveness Of Different Treatment Modalities

A 4-year Follow-up Evaluation Of A Pharmacist-managed Smoking Cessation Programme With Emphasis On Effectiveness Of Different Treatment Modalities

Progesterone and Postpartum Smoking Relapse: A Pilot Double-Blind Placebo-Controlled Randomized Trial

Quitting smoking before and after varenicline: a population study based on two representative samples of US smokers

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