Varenicline therapy increases smoking cessation rates

1. When compared to placebo, varenicline use for 24 weeks significantly increased smoking cessation rates at 3 months and 1 year.

2. Although clinical guidelines suggest quitting abruptly, varenicline may be a treatment option for patients with whom this is not an option.

Evidence Rating Level: 1 (Excellent)

Study Rundown: According to the CDC, 42.1 million adults in the United States currently smoke cigarettes. This accounts for more than 480,000 deaths every year and more than 16 million living with a smoking-related disease in our country. A number of smoking aids are currently on the market, many of which are nicotine substitutes. Varenicline, also known by the brand name Chantix, is a partial agonist at nicotinic acetylcholine receptors. It has been shown to increase smoking abstinence rates among smokers seeking to quit abruptly, as well as reduce cigarette consumption among those not actively trying to stop.

This study determined that varenicline may also be a helpful option for smokers are making attempts to reduce the number of cigarettes smoked per day with the goal of quitting. Participants demonstrated increased rates of smoking cessation at 3 months and 1 year following a 24-week course of varenicline. Strengths of this study include its randomized design and large sample size. It is limited by the extensive use of counseling and support the participants received during the trial, options that may not be available to all patients in a real world clinical setting. Nevertheless, this study highlights yet another regimen that clinicians can offer their patients for smoking cessation.

Click to read the study, published today in JAMA

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

In-Depth [randomized controlled trial]: This study evaluated 1510 participants from 61 centers in 10 countries between July 2011-July 2013. Inclusion criteria included having smoked 10 cigarettes per day or greater, and being willing to quit smoking over the next 3 months but not within the month. Participants went through a 24-week treatment followed by 28-week follow-up. Treatment groups were varenicline (n=760) or placebo (n=750). The varenicline group had higher rates of abstinence during weeks 15-24 (32.1% for the varenicline group vs. 6.9% for the placebo group; RD 25.2%, 95%CI 21.4%-29.0%; RR 4.6, 95%CI 3.5-6.1). Further, between weeks 21-52 the varenicline group showed similarly higher rates of abstinence (27.0% for the varenicline group vs. 9.9% for the placebo group; RD 17.1%, 95%CI 13.3%-20.9%; RR 2.7, 95%CI 2.1-3.5). After 8 weeks, 26.3% of those in the varenicline group reduced smoking by 75% or abstained vs. 15.1% of those in the placebo group (RD 11.3%, 95%CI 7.2%- 15.3%; RR 1.8, 95%CI 1.4-2.2).

Image: PD

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