Smoking cessation therapies may have similar quit rates
Compared with the nicotine patch, both varenicline and combination nicotine replacement therapy significantly reduced withdrawal and craving symptoms early, but the effect did not translate into superior 26- or 52-week abstinence.
Among adults motivated to quit smoking, 12 weeks of treatment with a nicotine patch, varenicline, or combination nicotine replacement therapy (C-NRT) produced similar confirmed rates of smoking abstinence at 26 or 52 weeks, a study showed.
Researchers randomly assigned more than 1,000 smokers to a 12-week smoking cessation pharmacotherapy group: nicotine patch only (n=241); varenicline only (including 1 prequit week; n=424); and C-NRT (nicotine patch and nicotine lozenge; n=421). Six counseling sessions were offered. The primary measured outcome was carbon monoxide-confirmed self-reported 7-day point-prevalence abstinence (the proportion of the study population abstinent at a specific point in time) at 26 weeks.
Results appeared in the Jan. 26 Journal of the American Medical Association.
Among 1,086 smokers randomized (52% women; 67% white; mean age, 48 years; mean of 17 cigarettes smoked per day), 917 people (84%) provided 12 months of follow-up data. Treatments did not differ on any abstinence outcome measure at 26 or 52 weeks. Point-prevalence abstinence rates at 26 weeks were 22.8% (55 of 241) for the nicotine patch; 23.6% (100 of 424) for varenicline; and 26.8% (113 of 421) for C-NRT. Point-prevalence abstinence rates at 52 weeks were 20.8% (50 of 241) for the nicotine patch; 19.1% (81 of 424) for varenicline; and 20.2% (85 of 421) for C-NRT. At 26 weeks, the risk differences for abstinence were −0.76% (95% CI, −7.4% to 5.9%) for patch versus varenicline; −4.0% (95% CI, −10.8% to 2.8%) for patch versus C-NRT; and −3.3% (95% CI, −9.1% to 2.6%) for varenicline versus C-NRT.
All medications were well tolerated, but varenicline produced more frequent adverse events than the nicotine patch, including vivid dreams, insomnia, nausea, constipation, sleepiness, and indigestion. Compared with the nicotine patch, both varenicline and C-NRT significantly reduced withdrawal and craving symptoms during the early post-target quit-day period, the authors wrote. In addition, C-NRT produced higher initial abstinence rates than did a nicotine patch or varenicline. However, neither of these early effects translated into superior 26- or 52-week abstinence.
Researchers attributed the lack of long-term pharmacotherapy effects to small effect sizes rather than low study power. And they noted that the study raised questions about the current relative effectiveness of intense smoking cessation drug therapies. “To our knowledge, this open-label study is the first to directly contrast varenicline and C-NRT pharmacotherapies, both with one another and with the nicotine patch. Results showed no significant differences among these 3 pharmacotherapies in any of the 26- or 52-week abstinence measures,” the authors wrote.