JAMA: Among cigarette smokers not willing or able to quit smoking in the
next month but willing to reduce with the goal of quitting in the next 3
months, use of the nicotine addiction medication varenicline for 24
weeks compared with placebo produced greater reductions in smoking prior
to quitting and increased smoking cessation rates at the end of
treatment and at 1 year, according to a study in the February 17 issue
of JAMA.
In a telephone survey of 1,000 current daily cigarette smokers, 44
percent reported a preference to quit through reduction in the number of
cigarettes smoked, and 68 percent would consider using a medication to
facilitate smoking reduction. However, U.S. clinical practice guidelines
recommend that smokers quit abruptly even though only 8 percent of
smokers report being ready to quit in the next month. Developing
effective interventions to achieve tobacco abstinence through gradual
reduction could engage more smokers in quitting, according to background
information in the study.
Jon O. Ebbert, M.D., M.Sc., of the Mayo Clinic, Rochester, Minn., and
colleagues randomly assigned 1,510 cigarette smokers to 24 weeks of
varenicline or placebo with a reduction target of 50 percent or more in
number of cigarettes smoked by 4 weeks, 75 percent or more by 8 weeks,
and a quit attempt by 12 weeks. The study was conducted at 61 centers in
10 countries. The participants were smokers who were not willing or
able to quit smoking within the next month but willing to reduce smoking
and make a quit attempt within the next 3 months.
The varenicline group (n = 760) had significantly higher continuous
abstinence rates during weeks 15 through 24 than the placebo group (n =
750) (32.1 percent vs 6.9 percent) and during weeks 21 through 24 (37.8
percent vs 12.5 percent) and weeks 21 through 52 (27.0 percent vs 9.9
percent).
At week 4, 47.1 percent of participants treated with varenicline
reduced the number of cigarettes smoked per day compared with baseline
by 50 percent or more or abstained completely compared with 31.1 percent
of participants treated with placebo; after 8 weeks, 26.3 percent
participants in the varenicline group reduced smoking by 75 percent or
more from baseline or abstained compared with 15.1 percent participants
in the placebo group.
Serious adverse events occurred in 3.7 percent of the varenicline
group and 2.2 percent of the placebo group. Varenicline was not
associated with significant increases in treatment discontinuations due
to adverse events.
“The U.S. Public Health Service and other guidelines recommend
smokers set a quit date in the near future 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. The
approach of reduction with the goal of quitting increases the options
for a clinician caring for a smoker,” the authors write.
(doi:10.1001/jama.2015.280; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor’s Note:
This study was funded by Pfizer. Please see the article for additional
information, including other authors, author contributions and
affiliations, financial disclosures, etc.