Varenicline with nicotine patch no better than varenicline alone for smoking cessation

Some previous research has supported the effectiveness of combination therapy with varenicline and nicotine replacement therapy (NRT) compared with varenicline alone. Some evidence also suggests that extending the duration of smoking cessation pharmacotherapy can enhance its efficacy. However, it remains uncertain whether combining varenicline with NRT or extending varenicline treatment duration increases smoking cessation rates. Read: Can dogs really help detect cancer? Looking at the issue, Wisconsin researchers conducted a randomized clinical trial to examine both treatment strategies among individuals expressing an interest in quitting smoking.1 The study specifically examined the efficacy of combining varenicline with the nicotine patch for smoking cessation, and the effects of extending the duration of varenicline or varenicline plus nicotine patch treatment from 12 weeks to 24 weeks.1 The study included 1,251 subjects who smoked five or more cigarettes per day. All study participants received six cessation counselling sessions, each lasting about 15 minutes, focusing on medication use, support, coping skills and motivation to quit. Read: Skin toxicities in cancer patients can be reduced with early care Participants were randomized to one of four medication groups: varenicline monotherapy for 12 weeks (n = 315), varenicline plus nicotine patch for 12 weeks (n = 314), varenicline monotherapy for 24 weeks (n = 311), or varenicline plus nicotine patch for 24 weeks (n = 311). The primary outcome was carbon monoxide–confirmed self-reported seven-day point prevalence abstinence (biologically confirmed with exhaled carbon monoxide level ≤ 5 ppm) at 52 weeks.1 Results showed that among the 1,251 patients who were randomized (mean age, 49.1 years; 54.0% women), 751 (60.0%) patients completed treatment and 881 (70.4%) provided final follow-up. The primary outcome of self-reported seven-day point prevalence abstinence at 52 weeks was 25.1% in the group receiving varenicline monotherapy for 12 weeks, 23.6% in the group receiving varenicline plus nicotine patch for 12 weeks, 24.4% in the group receiving varenicline monotherapy for 24 weeks, and 25.1% in the group receiving varenicline plus nicotine patch for 24 weeks. There were no statistically significant between-group differences.1 Across the four medication groups, nausea occurrence ranged from 24.0%–30.9% and insomnia occurrence ranged from 24.4% to 30.5%.2 Read: Lung cancer: new treatment approved for NSCLC The authors concluded that there were no significant differences in seven-day point prevalence abstinence at 52 weeks among those treated with combined varenicline plus nicotine patch therapy vs varenicline monotherapy, or among those treated for 24 weeks vs. 12 weeks. Their findings do not support the use of combined varenicline–nicotine patch therapy or an extended treatment duration. The authors note that it is unclear why standard varenicline combination therapy or extended varenicline monotherapy produced positive effects in some prior trials but showed little evidence of enhanced effectiveness in their current study.1 An accompanying editorial notes that the Wisconsin study used the exhaled carbon monoxide cutoff level of 5 ppm or less for confirmation of smoking cessation. Similar prior studies used a higher exhaled carbon monoxide cutoff (< 9 ppm or 10 ppm). The lower cutoff used to confirm smoking cessation in the Wisconsin study may have translated into the finding of lower cessation rates across all groups in the study.2 The editorial also points out that the participants in the Wisconsin trial had only moderate nicotine dependence. Further investigation is required to determine whether smokers with higher nicotine dependence could benefit from the combined use of varenicline and NRT or an extended duration of varenicline treatment. In addition, it would also be worthwhile to investigate whether more and/or longer counselling therapy sessions combined with various pharmacological strategies may increase smoking cessation rates. Read: Fighting cancer better with AI References 1. Baker TB, Piper ME, Smith SS, et al. Effects of combined varenicline with nicotine patch and of extended treatment duration on smoking cessation. A randomized clinical trial. JAMA 2021;326:1485-93. (accessed October 21, 2021). 2. Barua RS, Vindhyal M. Is there a role for combined use of varenicline and nicotine patch or extended treatment duration to enhance smoking cessation? JAMA 2021;326:1481-2. https://jamanetwork.com/journals/jama/fullarticle/2785281 (accessed October 21, 2021).

Varenicline with nicotine patch no better than varenicline alone for smoking cessation

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