Quitting smoking with varenicline: parallel, randomised efficacy trial in Iran

Heydari, Gholamreza; Talischi, Firouzeh; Tafti, Saeed Fallah; Masjedi, Mohammadreza

doi:10.5588/ijtld.11.0183

Cited by 35 publications

(55 citation statements)

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“…After the removal of duplicates and screening of titles and abstracts, 68 trials underwent full‐text review. In total, 38 RCTs met all eligibility criteria and were included in our meta‐analysis 10, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49…”

Section: Resultsmentioning

confidence: 99%

Varenicline and Adverse Cardiovascular Events: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Sterling

Windle

Filion

et al. 2016

JAHA

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BackgroundVarenicline is an efficacious smoking‐cessation drug. However, previous meta‐analyses provide conflicting results regarding its cardiovascular safety. The publication of several new randomized controlled trials (RCTs) provides an opportunity to reassess this potential adverse drug reaction.Methods and ResultsWe searched MEDLINE, EMBASE, and the Cochrane Library for RCTs that compare varenicline with placebo for smoking cessation. RCTs reporting cardiovascular serious adverse events and/or all‐cause mortality during the treatment period or within 30 days of treatment discontinuation were eligible for inclusion. Relative risks (RRs) with 95% CIs were generated by using DerSimonian–Laird random‐effects models. Thirty‐eight RCTs met our inclusion criteria (N=12 706). Events were rare in both varenicline (57/7213) and placebo (43/5493) arms. No difference was observed for cardiovascular serious adverse events when comparing varenicline with placebo (RR 1.03, 95% CI 0.72–1.49). Similar findings were obtained when examining cardiovascular (RR 1.04, 95% CI 0.57–1.89) and noncardiovascular patients (RR 1.03, 95% CI 0.64–1.64). Deaths were rare in both varenicline (11/7213) and placebo (9/5493) arms. Although 95% CIs were wide, pooling of all‐cause mortality found no difference between groups (RR 0.88, 95% CI 0.50–1.52), including when stratified by participants with (RR 1.24, 95% CI 0.40–3.83) and without (RR 0.77, 95% CI 0.40–1.48) cardiovascular disease.ConclusionsWe found no evidence that varenicline increases the rate of cardiovascular serious adverse events. Results were similar among those with and without cardiovascular disease. Given varenicline's efficacy as a smoking cessation drug and the long‐term cardiovascular benefits of cessation, it should continue to be prescribed for smoking cessation.

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Section: Resultsmentioning

confidence: 99%

Varenicline and Adverse Cardiovascular Events: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Sterling

Windle

Filion

et al. 2016

JAHA

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“…any formulations such as gums, spray and/or patches) although variations in population characteristics or clinical practice appear to influence the effectiveness of both therapies (Brose, West, & Stapleton, 2013). A randomized parallel clinical trial in 272 subjects reported equivalent success between varenicline and nicotine patches at 1, 6 and 12 months of follow-up (Heydari, Talischi, Tafti, & Masjedi, 2012), while a meta-analysis concluded that varenicline and combined NRT were equally effective in continuous or prolonged abstinence during at least 6 months (Cahill, Stevens, Perera, & Lancaster, 2013).…”

Section: Introductionmentioning

confidence: 99%

Association of nicotine metabolism and sex with relapse following varenicline and nicotine replacement therapy.

Glatard¹,

Dobrinas²,

Gholam‐Rezaee³

et al. 2017

Experimental and Clinical Psychopharmacology

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Nicotine is metabolized into cotinine and then into trans-3'-hydroxycotinine, mainly by cytochrome P450 2A6. Recent studies reported better effectiveness of varenicline in women and in nicotine normal metabolizers phenotypically determined by nicotine-metabolite ratio. Our objective was to study the influence of nicotine-metabolite ratio, CYP2A6 genotype and sex on the response to nicotine replacement therapy and varenicline. Data were extracted from a longitudinal study which included smokers participating in a smoking cessation program. Response to treatment was defined by the absence of relapse when a set threshold of reduction in cigarettes per day relative to the week before the study was no more reached. The analysis considered total and partial reduction defined by a diminution of 100% and of 90% in cigarettes per day, respectively. The hazard ratio of relapsing was estimated in multivariate Cox regression models including the sex and the nicotine metabolism determined by the phenotype or by CYP2A6 genotyping (rs1801272 and rs28399433). In the normal metabolizers determined by phenotyping and in women, the hazard ratio for relapsing was significantly Public Significance StatementsThis study confirms that varenicline has better effectiveness than nicotine replacement therapy in nicotine normal metabolizers determined by the nicotine-metabolite ratio, and in women. The nicotine normal metabolizers determined by CYP2A6 rs1801272 genotyping also have greater response to varenicline than to nicotine replacement therapy. The choice of the smoking cessation pharmacological treatment should take into account nicotine metabolism and sex to obtain better abstinence rate in smokers.

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“…Three papers were included from the updated search. [37][38][39] All three papers measured smoking cessation rates by PPA. The study reported in Cahill et al 15 as Pfizer 2011 40 was identified in the updated search as now being a published paper.…”

Section: Updated Searchmentioning

confidence: 99%

“…[37][38][39] All three studies were single-country studies, carried out in Canada, the USA, and Iran respectively. Wong et al 37 conducted the study at two sites -both pre-operative clinics in hospitals in Canada.…”

Section: Description Of Studies From Updated Searchmentioning

confidence: 99%

See 1 more Smart Citation

What is the clinical effectiveness and cost-effectiveness of cytisine compared with varenicline for smoking cessation? A systematic review and economic evaluation

Leaviss

Sullivan

Ren

et al. 2014

Health Technology Assessment

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Quitting smoking with varenicline: parallel, randomised efficacy trial in Iran

Abstract: In the study, varenicline treatment was slightly more effective than but not significantly different from nicotine replacement therapy.

Cited by 35 publications

References 0 publications

Varenicline and Adverse Cardiovascular Events: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Varenicline and Adverse Cardiovascular Events: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

Association of nicotine metabolism and sex with relapse following varenicline and nicotine replacement therapy.

What is the clinical effectiveness and cost-effectiveness of cytisine compared with varenicline for smoking cessation? A systematic review and economic evaluation

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