Use of Varenicline for 4 Weeks Before Quitting Smoking

Hájek, Peter; McRobbie, Hayden; Myers, Katherine; Stapleton, John; Dhanji, Al-Rehan

doi:10.1001/archinternmed.2011.138

Cited by 82 publications

(63 citation statements)

References 28 publications

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“…We hypothesized that the association between reduction and quitting reported previously 1, 2, 3, 5 could have arisen, because people felt that they ought to reduce smoking intentionally while using cessation medication. We did not find strong evidence that the strength of association between reduction and cessation varied by trial arm.…”

Section: Discussionmentioning

confidence: 99%

“…For each participant we calculated the percentage change in baseline CPD and CO between visits 1 and 3. We also dichotomized these variables because reduction by at least 50% has been used previously as, or has been found to be, an indicator of response to medications in research studies 3, 5.…”

Section: Methodsmentioning

confidence: 99%

“…Participants who reduced consumption by more than the median (56%) while smoking and using NRT were found in one study to be more than three times more likely to stop smoking than people reducing less than the median 3. Similarly, in people using varenicline for 4weeks prior to quit day, those who reduced consumption (indicated by cotinine concentration) by more than 50% were approximately three times more likely to achieve abstinence than those not reducing by this amount 5. However, in three cases of the aforementioned studies 1, 2, 5 observations were post hoc , which makes interpretation difficult.…”

Section: Introductionmentioning

confidence: 98%

“…Similarly, in people using varenicline for 4weeks prior to quit day, those who reduced consumption (indicated by cotinine concentration) by more than 50% were approximately three times more likely to achieve abstinence than those not reducing by this amount 5. However, in three cases of the aforementioned studies 1, 2, 5 observations were post hoc , which makes interpretation difficult. Evidence in a similar field suggests that initial findings of observational associations tend to overestimate the strength of association 6.…”

Section: Introductionmentioning

confidence: 98%

“…The second aim is to examine two plausible mechanisms that might explain this association. The explanation favoured by the investigators in the aforementioned studies 1, 2, 3, 5 is that smoking reduction is unwilled and occurs because medication met the need to smoke, and hence will support smokers adequately after they try to stop smoking. However, there is a second possible explanation.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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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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Is Varenicline Effectiveness Declining in Randomized Trials?

Md¹

2011

Arch Intern Med

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Is Varenicline Effectiveness Declining in Randomized Trials?—Reply

Hájek¹,

McRobbie²,

Myers³

et al. 2011

Arch Intern Med

Self Cite

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Our findings contrast with the only other study with prospectively measured BMI in both early and later life, which found that elevated body weight in adolescence exerted an effect on CHD after adjusting for adiposity in midlife. 4 In that study, there were considerably fewer deaths and therefore lower statistical power. In another prospective study, being overweight in college was associated with increased risk of future cardiovascular disease mortality, but no adjustment was made for subsequent BMI. 3 While the Harvard Alumni Health Study has several advantages-its sample size and number of end points, a range of collateral data, and repeated BMI measurements-it is not without its shortcomings. While there is growing evidence to suggest that body composition (eg, central adiposity) in middle and older age is associated with CHD, the only measurement of adiposity available to us was BMI. Furthermore, the present analyses are restricted to men; it is plausible, although perhaps unlikely, that different results may have been seen in women.In conclusion, the apparent doubling of future CHD risk in men who were obese in early adulthood was effectively eliminated following control for BMI in middle age. These results require replication in other studies.

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Use of Varenicline for 4 Weeks Before Quitting Smoking

Cited by 82 publications

References 28 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?

Is Varenicline Effectiveness Declining in Randomized Trials?

Is Varenicline Effectiveness Declining in Randomized Trials?—Reply

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