Increasing Varenicline Dose in Smokers Who Do Not Respond to the Standard Dosage

Hájek, Peter; McRobbie, Hayden; Smith, Katherine; Phillips, Anna C.; Cornwall, Danielle; Dhanji, Al-Rehan

doi:10.1001/jamainternmed.2014.6916

Cited by 22 publications

(13 citation statements)

References 20 publications

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“…However, these results are clouded by the fact that evidence suggests there may be a benefit of bupropion plus NRT over NRT alone (although this is uncertain) 14, and that varenicline appears to be more effective than NRT 15, suggesting that the results may be due to more efficacious medication per se rather than tailoring to the response to NRT itself. In the second trial, participants were asked to use varenicline for 3 weeks prior to quitting 13. Those in whom smoking was not suppressed were randomized to either continue on the standard dose or have the dose of varenicline increased.…”

Section: Discussionmentioning

confidence: 99%

Does cigarette reduction while using nicotine replacement therapy prior to a quit attempt predict abstinence following quit date?

et al. 2016

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Background and AimsPrevious studies have reported that people who use a smoking cessation medication while smoking and reduce cigarette consumption spontaneously are three times more likely to stop smoking after a quit date. The aim was to replicate this and assess whether it arises because of willed effortful reduction rather than unwilled reduced drive to smoke caused by medication.DesignSecondary analysis of a trial where participants were randomised to smoke as normal or reduce by 75% over 2 weeks prior to quit date, using nicotine replacement therapy (NRT) in both arms.SettingThirty‐one UK primary care practices.ParticipantsA total of 517 adult smokers seeking quitting support in the carbon monoxide (CO) analyses and 421 in the cigarettes/day analyses.MeasurementsRussell Standard abstinence was recorded 4 weeks after quit date. The randomized groups were combined and the association between reduction and abstinence examined. The second analysis assessed whether this association differed by whether smokers were, or were not, instructed to reduce.FindingsIn all participants, there was no evidence that reducing cigarettes/day or CO by at least half compared with not reducing predicted abstinence at 4 weeks [risk ratio (RR) = 0.88; 95% confidence interval (CI) = 0.68–1.14 and RR = 1.20; 95% CI = 1.00–1.44, respectively]. However, in smokers instructed to reduce, CO reduction was associated with 4‐week abstinence (RR = 1.52; 95% CI = 1.16–2.00), but not among people advised not to reduce (RR = 0.91; 95% CI = 0.67–1.24).ConclusionsSmoking reduction prior to a target quit date while on a smoking cessation medication may only predict subsequent abstinence when smokers are consciously attempting to reduce.

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Section: Discussionmentioning

confidence: 99%

Does cigarette reduction while using nicotine replacement therapy prior to a quit attempt predict abstinence following quit date?

et al. 2016

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“…In this study no significant improvement in smoking-abstinence rates was found by increasing the dose beyond 2 mg/day. 16 …”

Section: Introductionmentioning

confidence: 99%

Improvement of Smoking Abstinence Rates With Increased Varenicline Dosage

Karam‐Hage¹,

Kypriotakis²,

Robinson³

et al. 2018

J Clin Psychopharmacol

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Purpose/Background It is unclear whether increasing the dose of varenicline beyond the standard dose of 2 mg/day would improve smoking abstinence. Methods/Procedures We examined the effect of 3 mg/day of varenicline on smoking abstinence among smokers who had reduced their smoking by 50% or more in response to 2 mg/day for at least 6 weeks but had not quit smoking. Of 2833 patients treated with varenicline, a subset of 73 smokers were increased to 3 mg/day after 6 weeks. We used a propensity score analysis involving multiple baseline covariates to create a comparative sample of 356 smokers who remained on 2 mg/day. All smokers received concurrent and similar smoking-cessation counseling. Findings/Results At 3 months, we found higher 7-day PPA rate in the 3-mg group (26%) than in the 2-mg group (11.5%; χ2=10.60; p<0.001; Risk Ratio (RR)= 2.3 [95% confidence interval, 1.4–3.6]). The difference in abstinence rates remained significant at the 6 months (p<0.001; RR= 2.6 [95% confidence interval, 1.6–3.9]) and 9 months follow-up (p<0.001; RR= 2.2 [95% confidence interval, 1.4–3.3]). Implications/Conclusions We conclude that a relatively small increase in the daily dose of varenicline seems to offer a benefit for those who are not able to achieve total abstinence after ~6 weeks of 2 mg/day.

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“…Исключены исследования, имеющие целью проверить влияние варениклина на алкогольную зависимость, спинномозговую атаксию, приверженность лечению у групп с ВИЧ, низкоуглеводную диету и диету со сниженным содержанием жира [8,32,43,70,92,119]. Также исключили работы с существенно измененной длительностью курса приема варениклина [23,26,33,38,39,41,52,74,78,100,106]. Исключены исследования, у которых отсутствовала контрольная группа [31].…”

Section: Introductionunclassified

Network meta-analysis: a comparison of effectiveness and safety of partial agonists of nicotinic acetylcholine receptors varenicline and cytisine for smoking cessation

Radchenko

Владимировна²,

Sykhovskaya

et al. 2018

Rev Clin Pharm Drug Ther

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Background. Partial agonists of α4b2 nicotinic acetylcholine receptors are the most effective treatment strategy for tobacco smoking cessation. They are able to alleviate withdrawal symptoms and to reduce smoking satisfaction. The aim of this study was to review the efficacy and safety of nicotinic receptor partial agonists varenicline and cytisine, for smoking cessation. Methods. A search for randomized controlled trials was done using the terms (“cytisine”, “tabex”, “varenicline” or 'partial agonists of nicotinic receptors’) in MEDLINE, EMBASE, eLibrary in May 2018. Types of participants, the doses and duration of the treatments, efficacy and safety parameters, quality of randomization and blinding procedures were evaluated. Bayesian network meta-analysis was performed. Results. Cytisine overcame placebo in the 12, 24 and 52 weeks of therapy with the following odds ratios (ORs) for abstinence: 3.3 (95% CrI 1.8–5.8), 3.9 (2.4–6.7), 3.8 (CrI 1.3–11,9) accordingly. Varenicline in 2 mg/day dose overcame placebo in the 12, 24 and 52 weeks of therapy with the ORs: 4.0 (3.3–4.7), 3.1 (2.5–3.7), 2.9 (2.2–4.1) accor dingly. Varenicline in 1 mg/day dose overcame placebo in 12 and 52 weeks of therapy, the ORs were 3.0 (2.0–4.7) and 2.3 (1.3–4.4) accordingly. Varenicline in 0.5 mg/day dose overcame placebo in 12 weeks of therapy only with the OR 2.4 (1.3–4.4). Cytisine and varenicline 2 mg/day were associated with more gastrointestinal disturbances than placebo with the ORs 6.2 (2.1–22.8) and 2.4 (2.0–2.8) accordingly. Cytisine and varenicline 2 mg/day were associated with more psychiatric problems than placebo with ORs 5.2 (1.9–15.1) and 1.6 (1.3–1.9) accordingly. There was no difference in serious adverse events between the investigated drugs and placebo: OR for cytisine was 2.4 (0.8–6.8), varenicline 0.5 mg/day – 2.0 (0.5–6.6), varenicline 1.0 mg/day – 1.0 (0.3–2.7), varenicline 2 mg/day – 1.0 (0.7–1.4). Conclusion. Cytisine was proved to be as effective and safe aid for smoking cessation as varenicline.

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Increasing Varenicline Dose in Smokers Who Do Not Respond to the Standard Dosage

Cited by 22 publications

References 20 publications

Does cigarette reduction while using nicotine replacement therapy prior to a quit attempt predict abstinence following quit date?

Does cigarette reduction while using nicotine replacement therapy prior to a quit attempt predict abstinence following quit date?

Improvement of Smoking Abstinence Rates With Increased Varenicline Dosage

Network meta-analysis: a comparison of effectiveness and safety of partial agonists of nicotinic acetylcholine receptors varenicline and cytisine for smoking cessation

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