Varenicline effective for gradual smoking termination, offering alternative to guideline

Smokers who can’t quit cigarettes in one month can succeed gradually by using  the nicotine addiction medication varenicline for 24 weeks, researchers reported on February 17, 2015 in JAMA/Journal of the American Medical Association.

As background, the authors noted that the U.S. Public Health Service and other guidelines suggest that smokers set an early quit date and quit abruptly. “However, many smokers may be unwilling to commit to a quit date at a clinic visit. Because most clinicians are likely to see smokers at times when a quit date in the next month is not planned, the current study indicates that prescription of varenicline with a recommendation to reduce the number of cigarettes smoked per day with the eventual goal of quitting could be a useful therapeutic option for this population of smokers.” they said.

Jon Ebbert, M.D., M.Sc., of the Mayo Clinic in Rochester, Minnesota., and colleagues randomized 1,510 cigarette smokers to 24 weeks of varenicline or placebo. The reduction target was 50 percent or more fewer cigarettes by 4 weeks, 75 percent by 8 weeks, and a quit attempt by 12 weeks.

The study was international, involving 61 sites in 10 countries.

Eligible subjects were not willing or able to quit smoking within a month but willing to cut back and make a quit attempt within 3 months.

The investigators reported that the varenicline group (n = 760) achieved significantly higher continuous abstinence rates during weeks 15 through 24 than the placebo group (n = 750; 32.1 percent vs 6.9 percent), during weeks 21 through 24 (37.8 percent vs 12.5 percent) and during weeks 21 through 52 (27.0 percent vs 9.9 percent).

By week four, 47.1 percent of  varenicline-treated subjects had reduced their cigarettes per day by 50 percent or more compared with baseline, or had quit completely, compared with 31.1 percent of subjects in the placebo group. And at week 8, 26.3 percent of varenicline-treated subjects had cut their smoking by 75 percent or more from baseline, or had quit, compared with 15.1 percent of subjects in the placebo group.

Serious adverse events appeared in 3.7 percent of the varenicline-treated subjects and 2.2 percent of the subjects in the placebo group. Notably, varenicline treatment did not lead to a significant increase in treatment discontinuation due to adverse events.

“The approach of reduction with the goal of quitting increases the options for a clinician caring for a smoker,” the authors concluded.