Effectiveness of varenicline for smoking cessation at 2 urban academic health centers

Md, Ranjit Dhelaria; Friderici, Jennifer; Wu, Kelly; Gupta, Ella; Khan, Cyrus; Rothberg, Michael B.

doi:10.1016/j.ejim.2012.03.017

Cited by 13 publications

(9 citation statements)

References 18 publications

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“…In contrast, in a non-randomized study performed in an inner city medical clinic, quit rates using varenicline and NRT were approximately 7% after 52 weeks (Dhelaria et al, 2012). This finding, despite the limitations of a retrospective observational study, suggests that obstacles to quitting such as mental illness and substance abuse, common in urban samples, lower quit rates.…”

Section: Discussionmentioning

confidence: 98%

Varenicline for smoking cessation among methadone-maintained smokers: A randomized clinical trial

Stein

Caviness

Kurth

et al. 2013

Drug and Alcohol Dependence

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Background With smoking rates far exceeding the general population, methadone-maintained (MMT) opiate-dependent smokers experience high rates of tobacco-related health consequences. Previous treatment studies have used nicotine replacement and produced low quit rates. Methods We test, using a three-group randomized design, the efficacy of varenicline vs. placebo, in comparison with nicotine replacement therapy (NRT) that combines nicotine patch prescription plus ad libitum nicotine rescue, for smoking cessation. We recruited methadone-maintained smokers from nine treatment centers in southern New England and provided six months of treatment, and a minimal behavioral intervention at baseline (NCI's 5A's). Outcomes included carbon monoxide (CO) confirmed 7-day point smoking cessation prevalence at 6 months and self-reported change in mean cigarettes per day. Results The 315 participants had a mean age of 40, with 50% male and 79% non-Hispanic White, smoked an average of 19.6 (± 10.4) cigarettes / day, and had a mean daily methadone dose of 109 mg. Intent-to-treat analyses, with missing considered to be smoking, showed the rate of CO-confirmed 7-day abstinence at 6-months was 5.4% overall, with varenicline 3.7% compared to placebo 2.2%, and NRT 8.3% (p>.05). Adherence rates during the 7-days immediately prior to 6-month assessment were 34.2% in varenicline, 34.4% in placebo, and 48.8% in NRT. Between baseline and 6-months there was an overall self-reported mean reduction of 8.3 cigarettes / day. Conclusion Varenicline did not increase quit rates over placebo. Smoking cessation rates in methadone-maintained smokers are low and novel treatment strategies are required.

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Section: Discussionmentioning

confidence: 98%

Varenicline for smoking cessation among methadone-maintained smokers: A randomized clinical trial

Stein

Caviness

Kurth

et al. 2013

Drug and Alcohol Dependence

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“…Studies of the effectiveness of varenicline in real world clinics were scarce, compared to RCTs. Dhelaria et al 20 conducted a retrospective cohort study at 2 urban academic health centres in the USA, and found that 10.2% patients who received varenicline and had at least one follow-up visit maintained abstinence through 1 year at the 52-week follow-up. Assuming those who had no follow-up had not quit, the overall quit rate was only 6.4%.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of varenicline and counselling for smoking cessation in an observational cohort study in China

Jiang

Zuo

et al. 2016

BMJ Open

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ObjectivesTo evaluate the effectiveness of varenicline for smoking cessation in Chinese smokers in a real world cessation clinic practice.DesignA prospective observational study.SettingBeijing, China.ParticipantsA total of 924 smokers (883 men and 41 women) who attended a smoking cessation clinic of a large general hospital were assessed with data from structured questionnaires at baseline and follow-up at 1, 3 and 6 months. Trained physician counsellors provided free individual counselling for all subjects and follow-up interviews with brief counselling. 332 subjects additionally prescribed varenicline according to their own choice were compared with those without varenicline.Main Outcome MeasuresPrimary outcomes were self-reported 7-day point prevalence abstinence rate and 3-month continuous abstinence rate at 6-month follow-up. Secondary outcomes were 7-day point prevalence abstinence rates at 1 and 3-month follow-up, and 1-month continuous abstinence rate at 3-month follow-up.ResultsBy intention-to-treat, the 7-day point prevalence abstinence rate with varenicline and counselling at 6 months was significantly higher than counselling only (37.0% vs 23.1%; OR, 1.75; 95% CI 1.46 to 2.62; p=0.001). The 3-month continuous abstinence rate at 6 months was higher with varenicline (33.1% vs 18.4%; OR, 2.04; 95% CI 1.61 to 2.99; p<0.001). Varenicline also showed better secondary outcomes.ConclusionsVarenicline prescription in the smoking cessation clinic appeared to be effective with doubling of quit rates in Chinese smokers in a real world cessation clinic practice.Clinical trial registrationNCT01935505; Results.

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“…Meta-analyses of Randomized Controlled Trials (RCT’s) show that traditional quit-smoking interventions are effective in comparison to placebo [ 9 ], but the six-month quit rates remain disappointingly low [ 10 ] and relapse rates are typically high [ 11 ]. Moreover, some recent studies have failed to find that these medications are effective in real-world use; e.g., the biologically validated smoking cessation rates for NRT and varenicline are typically around 10% or lower [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of the Electronic Cigarette: An Eight-Week Flemish Study with Six-Month Follow-up on Smoking Reduction, Craving and Experienced Benefits and Complaints

Adriaens

Gucht

Declerck

et al. 2014

IJERPH

189

171

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Background: Smoking reduction remains a pivotal issue in public health policy, but quit rates obtained with traditional quit-smoking therapies remain disappointingly low. Tobacco Harm Reduction (THR), aiming at less harmful ways of consuming nicotine, may provide a more effective alternative. One promising candidate for THR are electronic cigarettes (e-cigs). The aim of this study was to investigate the efficacy of second-generation e-cigs both in terms of acute craving-reduction in the lab and in terms of smoking reduction and experienced benefits/complaints in an eight-month Randomized Controlled Trial (RCT). Design: RCT with three arms. Methods: Participants (N = 48) unwilling to quit smoking were randomized into two e-cig groups and one control group. During three lab sessions (over two months) participants, who had been abstinent for four hours, vaped/smoked for five minutes, after which we monitored the effect on craving and withdrawal symptoms. eCO and saliva cotinine levels were also measured. In between lab sessions, participants in the e-cig groups could use e-cigs or smoke ad libitum, whereas the control group could only smoke. After the lab sessions, the control group also received an e-cig. The RCT included several questionnaires, which repeatedly monitored the effect of ad libitum e-cig use on the use of tobacco cigarettes and the experienced benefits/complaints up to six months after the last lab session. Results: From the first lab session on, e-cig use after four hours of abstinence resulted in a reduction in cigarette craving which was of the same magnitude as when a cigarette was smoked, while eCO was unaffected. After two months, we observed that 34% of the e-cig groups had stopped smoking tobacco cigarettes, versus 0% of the control group (difference p < 0.01). After five months, the e-cig groups demonstrated a total quit-rate of 37%, whereas the control group showed a quit rate of 38% three months after initiating e-cig use. At the end of the eight-month study, 19% of the e-cig groups and 25% of the control group were totally abstinent from smoking, while an overall reduction of 60% in the number of cigarettes smoked per day was observed (compared to intake). eCO levels decreased, whereas cotinine levels were the same in all groups at each moment of measurement. Reported benefits far outweighed the reported complaints. Conclusion: In a series of controlled lab sessions with e-cig naïve tobacco smokers, second generation e-cigs were shown to be immediately and highly effective in reducing abstinence induced cigarette craving and withdrawal symptoms, while not resulting in increases in eCO. Remarkable (>50 pc) eight-month reductions in, or complete abstinence from tobacco smoking was achieved with the e-cig in almost half (44%) of the participants.

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Effectiveness of varenicline for smoking cessation at 2 urban academic health centers

Cited by 13 publications

References 18 publications

Varenicline for smoking cessation among methadone-maintained smokers: A randomized clinical trial

Varenicline for smoking cessation among methadone-maintained smokers: A randomized clinical trial

Effectiveness of varenicline and counselling for smoking cessation in an observational cohort study in China

Effectiveness of the Electronic Cigarette: An Eight-Week Flemish Study with Six-Month Follow-up on Smoking Reduction, Craving and Experienced Benefits and Complaints

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