Efficacy of Varenicline to Prompt Quit Attempts in Smokers Not Currently Trying to Quit: A Randomized Placebo-Controlled Trial

Abstract

Introduction: Nicotine replacement therapy to aid smoking reduction increases the probability of a future quit attempt among smokers not currently planning to quit smoking. We tested whether varenicline, a partial nicotine agonist, would also increase future quit attempts. Methods:This randomized, placebo-controlled trial recruited 218 smokers who were interested in quitting but had no plans to quit in the next month. Participants used varenicline (2 mg/day) or placebo for 2-8 weeks plus received brief counseling on methods to reduce cigarettes/day. The primary measure was the incidence of a quit attempt within 6 months of study entry. Secondary measures were point prevalence abstinence, motivation to stop smoking, and reduction in cigarettes/day. Results:Varenicline increased the incidence of a quit attempt more than placebo at the Nebraska site (73% vs. 41%; p < .001) but not at the Vermont site (45% vs. 51%; p = .45). Varenicline increased most other measures of quit attempts, motivation and abstinence, independent of site. The beneficial effects of varenicline in quit attempts appeared to be mediated by greater reductions in cigarettes/day, dependence, craving, and cigarette satisfaction. Varenicline had a greater effect on quit attempts in less-dependent smokers, in minority smokers, and in those who had less prior cessation or reduction activity. Adverse events were minimal. Conclusions:Varenicline increased quit attempts in smokers who are not currently trying to quit at one of the two study sites and improved most all secondary outcomes independent of site. This appeared to be due to decreasing cigarettes/day and level of dependence.

Achieving Smoking Cessation in Individuals with Schizophrenia: Special Considerations

“…This practice allows patients and treaters to establish the tolerability of the new pharmacotherapeutic smoking cessation aid prior to the quit date. This allows both patients and treaters to separate potential medication-related neuropsychiatric adverse events from nicotine withdrawal symptoms and is consistent with the flexible quit approach outlined in FDA prescribing information for varenicline [75, 76]. The result of separating initiation of pharmacotherapy from the quit attempt by several weeks, in our experience, is to increase treatment acceptance and adherence, leading to increased duration of treatment with the smoking cessation pharmacotherapy and increased abstinence rates.…”

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

“…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…”

Effects of 21 days of varenicline versus placebo on smoking behaviors and urges among non-treatment seeking smokers

“…According to current treatment recommendations, the target quit day would have occurred three days prior to the observed decrease in CPD in the current study. Reducing cigarette consumption prior to a quit attempt may be important for reducing the severity of withdrawal symptoms and urges to smoke (Hughes et al, 2011). Furthermore, pre-treatment with nicotine replacement therapy enhances abstinence rates and may reduce urges to smoke, suggesting that the effect of pre-treatment may not be specific to varenicline (Rose, 2011; Rose et al, 2006; Shiffman and Ferguson, 2008).…”