Efficacy of Varenicline for Cigarette Reduction Before Quitting in Japanese Smokers: A Subpopulation Analysis of the Reduce to Quit Trial

Nakamura, Masakazu; Abe, Masaaki; Ohkura, Masayuki; Treadow, Joan; Yu, Ching-Ray; Park, Peter W.

doi:10.1016/j.clinthera.2017.03.007

Cited by 7 publications

(6 citation statements)

References 14 publications

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“…With this paradigm, CAR15-24 were significantly higher for varenicline versus placebo (32.1% vs. 6.9%; RR, 4.6; 95% CI: 3.5, 6.1). Similar results were observed for CAR21-24 and CAR21-52 53 and for the Japanese sub-population 54 .…”

Section: Efficacysupporting

confidence: 86%

“…This approach has been evaluated in smokers unwilling or unable to quit immediately. In a study of 1510 participants 53 (including 210 Japanese participants who were also analyzed separately 54 ) smokers were asked to reduce their smoking rate by at least 50% after 4 weeks of varenicline, with a further 50% reduction from week 4 to week 8, and a goal of total abstinence at week 12. Participants were to continue varenicline treatment until week 24.…”

Section: Efficacymentioning

confidence: 99%

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Varenicline: mode of action, efficacy, safety and accumulated experience salient for clinical populations

Tonstad

Arons

Rollema³

et al. 2020

Current Medical Research and Opinion

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Objective: Varenicline, a selective partial agonist of the a4b2 nicotinic acetylcholine receptor, is a smoking cessation pharmacotherapy that more than doubles the chance of quitting smoking at 6 months compared with placebo. This article reviews salient knowledge of the discovery, pharmacological characteristics, and the efficacy and safety of varenicline in general and in specific populations of smokers and provides recommendations to support use in clinical practice. Methods: Literature searches for varenicline were conducted using PubMed, with date limitations of 2000-2018 inclusive, using search terms covering the discovery, mechanism of action, pharmacokinetics, efficacy and safety in different populations of smokers, alternative quit approaches and combination therapy. Selection of safety and efficacy data was limited to clinical trials, meta-analyses and observational studies. Results: Standard administration of varenicline is efficacious in helping smokers to quit, including smokers with cardiovascular disease and chronic obstructive pulmonary disease. Furthermore, varenicline efficacy may be improved with pre-loading, a gradual quitting approach for smokers unwilling or unable to quit abruptly, and extended treatment in smokers who have recently quit to help maintain abstinence. Initial concerns regarding the association of varenicline with increased risk of neuropsychiatric and cardiovascular adverse events have been disproven after extensive clinical evaluations, and the benefit-risk profile of varenicline is considered favorable. Conclusions: Varenicline is efficacious and safe for all adult smokers with a range of clinical characteristics. Evidence suggests that approaches offering greater flexibility in timing and duration of treatment may further extend treatment efficacy and clinical reach.

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Section: Efficacysupporting

confidence: 86%

Section: Efficacymentioning

confidence: 99%

Varenicline: mode of action, efficacy, safety and accumulated experience salient for clinical populations

Tonstad

Arons

Rollema³

et al. 2020

Current Medical Research and Opinion

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“…All studies focused on adult populations, and most focused on the general public ( n = 43) [ 32 , 33 , 35 , 37 , 39 – 45 , 48 – 53 , 55 , 59 , 60 , 62 , 63 , 65 , 67 , 69 – 74 , 76 , 77 , 79 – 81 , 83 , 85 – 88 , 90 , 91 , 93 ]. A few studies investigated specific patient populations: cancer ( n = 3) [ 34 , 36 , 82 ]; chronic obstructive pulmonary disease ( n = 3) [ 61 , 75 , 78 ]; human immunodeficiency viruses ( n = 3) [ 54 , 58 , 66 ]; psychiatric conditions ( n = 2) [ 46 , 84 ]; and people undergoing substance use disorder treatment, including methadone treatment ( n = 2) [ 47 , 56 ].…”

Section: Resultsmentioning

confidence: 99%

“…A few studies investigated specific patient populations: cancer ( n = 3) [ 34 , 36 , 82 ]; chronic obstructive pulmonary disease ( n = 3) [ 61 , 75 , 78 ]; human immunodeficiency viruses ( n = 3) [ 54 , 58 , 66 ]; psychiatric conditions ( n = 2) [ 46 , 84 ]; and people undergoing substance use disorder treatment, including methadone treatment ( n = 2) [ 47 , 56 ]. There was a fairly even gender split among participants in the included studies, although 20 studies reported 30% or fewer female participants [ 71 , 72 , 38 , 39 , 77 – 79 , 46 , 48 , 80 , 81 , 89 , 54 , 84 , 55 , 58 , 92 , 65 , 66 , 86 ]. Table 1 provides a summary of the included studies.…”

Section: Resultsmentioning

confidence: 99%

Identifying determinants of varenicline adherence using the Theoretical Domains framework: a rapid review

Minian,

Wong,

Hafuth

et al. 2024

BMC Public Health

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Background Adhering to varenicline has been shown to significantly improve the chances of successfully quitting smoking, with studies indicating a twofold increase in 6-month quit rates. However, despite its potential benefits, many individuals struggle with maintaining good adherence to varenicline; thus there is a need to develop scalable strategies to help people adhere. As a first step to inform the development of an intervention to improve adherence to varenicline, we conducted a rapid literature review to identify: 1) modifiable barriers and facilitators to varenicline adherence, and 2) behaviour change techniques associated with increased adherence to varenicline. Methods We searched MEDLINE, Embase, APA PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials for relevant studies published between 2006 and 2022. Search terms included “varenicline,” “smoking cessation,” and "adherence," and their respective subject headings and synonyms. We screened and included studies reporting modifiable determinants of adherence to varenicline and then assessed quality, extracted modifiable determinants and mapped them to the Theoretical Domains Framework version 2 and the Behaviour Change Technique Taxonomy version 1. Results A total of 1,221 titles were identified through the database searches; 61 met the eligibility criteria. Most of the studies were randomized controlled trials and predominantly focused on barriers to varenicline. Only nine studies explicitly mentioned behaviour change techniques used to help varenicline adherence. Eight domains were identified as barriers to varenicline adherence (behavioural regulation, memory, goals, intentions, beliefs about capabilities, beliefs about consequences, optimism/pessimism, and environmental context) and five as facilitators (knowledge, behavioural regulation, beliefs about capabilities, social influences, and environmental context). Conclusions This study identifies barriers and facilitators that should be addressed when developing a complex adherence intervention tailored to patients’ needs based on modifiable determinants of medication adherence, some of which are under- used by existing adherence interventions. The findings from this review will inform the design of a theory-based healthbot planned to improve varenicline adherence in people undergoing smoking cessation treatment. Systematic review registration This study was registered with PROSPERO (# CRD42022321838).

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“…However, current guidelines for smoking cessation recommend abrupt quitting interventions for smokers who make active quit attempts 3 . In clinical practice, some smokers cannot quit smoking abruptly due to the high addiction to tobacco and the lack of psychological preparedness for smoking cessation, but they can achieve ultimate abstinence by gradually reducing tobacco use 4 . Gradual cessation means gradually reducing the number of cigarettes smoked as planned over a predetermined period of time, which allows time for smokers to adapt both physiologically and psychologically.…”

Section: Introductionmentioning

confidence: 99%

Abrupt versus gradual smoking cessation with pre-cessation varenicline therapy for Chinese treatment-seeking smokers: A retrospective, observational, cohort study

Zhu¹,

Lin²,

Dai³

et al. 2022

Tob. Induc. Dis.

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INTRODUCTION This study aimed to explore the efficacy of abrupt and gradual smoking cessation with pre-cessation varenicline therapy. METHODS A total of 278 smokers who experienced moderate-to-severe nicotine dependence and visited a Chinese smoking cessation outpatient clinic from March 2017 to February 2021 were enrolled. This was a retrospective, observational, cohort study. Participants were divided into two groups by the cessation strategy they received: the abrupt cessation group (n=139, tobacco was not controlled during the first 3 weeks before the target cessation date and smoking was entirely discontinued on the 22nd day) and the gradual cessation group (n=139, tobacco was gradually reduced in the first 3 weeks before the target cessation date and smoking was discontinued on the 22nd day). The abstinence rates were compared between groups (7-day point prevalence abstinence rates at 1, 3 and 6 months post-treatment; and 1-month and 3-month continuous abstinence rates of 6-month follow-up). Possible factors that influence efficacy, reasons for smoking cessation failure, and associated adverse events were also analyzed. RESULTS No significant difference in the 7-day point prevalence abstinence rates at 1, 3 and 6 months post-treatment was observed between the groups (p>0.05). The 1-month continuous abstinence rate of the gradual cessation group was higher than that of the abrupt cessation group (51.1% vs 31.7%; χ 2 =10.812, p=0.001). The 3-month continuous abstinence rate of the gradual cessation group was also higher than that of the abrupt cessation group (42.4% vs 27.3%; χ 2 =6.983, p=0.008). Abrupt cessation was a risk factor for successful smoking cessation than gradual cessation (AOR=2.39; 95% CI: 1.15–3.85, p=0.013),the motivation of ‘prevention and treatment of own diseases’ reduced the risk of incomplete abstinence (AOR=0.87; 95% CI: 0.38–0.99, p=0.049). The incidence of adverse events was higher in the abrupt cessation group than in the gradual cessation group. The incidence rates of nausea and insomnia were statistically significant differences. CONCLUSIONS Compared with abrupt cessation, gradual smoking cessation with pre-cessation varenicline therapy produced higher abstinence rates and relatively milder withdrawal symptoms.

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Efficacy of Varenicline for Cigarette Reduction Before Quitting in Japanese Smokers: A Subpopulation Analysis of the Reduce to Quit Trial

Cited by 7 publications

References 14 publications

Varenicline: mode of action, efficacy, safety and accumulated experience salient for clinical populations

Varenicline: mode of action, efficacy, safety and accumulated experience salient for clinical populations

Identifying determinants of varenicline adherence using the Theoretical Domains framework: a rapid review

Abrupt versus gradual smoking cessation with pre-cessation varenicline therapy for Chinese treatment-seeking smokers: A retrospective, observational, cohort study

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