{"id":410,"date":"2014-09-30T15:45:27","date_gmt":"2014-09-30T15:45:27","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=410"},"modified":"2017-08-21T12:09:35","modified_gmt":"2017-08-21T12:09:35","slug":"primary-care-corner-with-geoffrey-modest-smoking-cessation-with-combo-varenicline-and-nicotine-patches","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/09\/30\/primary-care-corner-with-geoffrey-modest-smoking-cessation-with-combo-varenicline-and-nicotine-patches\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest: Smoking cessation with combo varenicline and nicotine patches"},"content":{"rendered":"

I\u00a0have posted a few blogs in the past year or so on the potential of the combination of varenicline plus nicotine patch. This is not an intuitive combo, since varenicline\u200b blocks with high affinity\u00a0the nicotinic cholinergic receptor a4<\/sub>b2<\/sub>, presumably the principal mediator of nicotine dependence,\u00a0both\u00a0blocking nicotine effects but also with\u00a0some agonist activity —\u00a0though there may be other important receptors involved as well. JAMA published the\u00a0largest study on the combo (see DOI:10.1001\/jama.2014.7195<\/strong>). South African study of\u00a0435\u00a0smokers randomized to\u00a012-week intervention of varenicline plus placebo patch\u00a0vs. varenicline plus nicotine patch. <\/span><\/p>\n

Details:<\/span><\/strong><\/p>\n

–Nicotine or placebo patch (15-mg nicotine patch, left on for 16h\/day)\u00a0begun 2 weeks before target quit date (TQD). Varenicline begun 1 week before. All continued until week 12 after TQD. Varenicline begun with usual up-titration\u00a0(as per the chantix starter packet), and similarly tapered down in the last week.<\/p>\n

–Mean age of patients was 46.3, mean smoking\u00a016 cigarettes\/d,\u00a026.5 years of smoking with therefore\u00a021 pack-years smoking, 1.5 previous quit attempts. 62% completed the study<\/span><\/p>\n

–Primary endpoint: the % of people able to maintain complete abstinence from smoking for the last 4 weeks of treatment. Secondary endpoint was point prevalence of abstinence at 6 months. Continuous rate of abstinence from weeks 9-24, and adverse events. Tobacco abstinence determined by carbon monoxide measurements at TQD\u200b and up to 24 weeks later<\/span><\/p>\n

–Combo treatment associated with higher continuous abstinence rate at 12 weeks (55.4% vs 40.9%;\u00a0OR 1.85 [1.19-2.89], p=0.007); and at 24 weeks (49.0% vs 32.6%; OR 1.98 [1.25-3.14], p=0.004); and point prevalence abstinence\u00a0at 6 months (65.1% vs\u00a046.7%; OR 2.13 [1.32-3.43], p=0.002). Interestingly, the combo therapy did not decrease nicotine craving more than\u00a0varenicline alone.<\/span><\/p>\n

–More nausea in combo group, as well as sleep disturbance, skin reactions (mostly\u00a0from the patch), constipation, and depression; but only skin reactions reached statistical significance (14.4% vs 7.8%, p=0.03). The\u00a0varenicline alone group had more abnormal dreams and headaches (non-significant). Overall mean weight gain was 3.0 kg in the combo group and 2.2\u00a0kg with\u00a0varenicline alone.<\/span><\/p>\n

S<\/span>o, very impressive abstinence rates with combo therapy. combo therapy overall is better than monotherapy (even combo of long-acting nicotine\u00a0patches with short-acting nicotine gum\/lozenges, as well as combo of patches with bupropion). It would be interesting to have head-to-head comparison of\u00a0varenicline\/patch vs. bupropion\/patch vs. combo patch\/gum to find the most advantageous combination. \u00a0But this study, I think, is an important one, adding a potent combo therapy to help people decrease the most significant preventable\u00a0cause of morbidity\/mortality from cardiovasc and respiratory diseases.<\/p>\n

Geoff<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Smoking cessation with combo varenicline and nicotine patches […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-410","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/410","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=410"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/410\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=410"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=410"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=410"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}