Does extending pre-quit date varenicline treatment increase success in smoking cessation?

Hi! Dr. Heinzerling back on the air with info on results of a new study looking at pre-quit date use of varenicline and outcomes in smoking cessation treatment. The study is from Peter Hajek and colleagues and can be found here. Some quick background first. Varenicline (Chantix) is a partial agonist at the alpha4beta2 nicotine receptor, one of the major receptors that nicotine in cigarette smoke hits and a receptor that plays a critical role in nicotine dependence. Varenicline is approved for smoking cessation treatment and standard treatment involves starting varenicline one week before the smoker's target quit date. During this first week, varenicline is slowly increased to the therapeutic dose (to minimize nausea the most common side effect with varenicline) and the smoker is told to smoke on top of the varenicline during the week of dose titration. The patient then attempts to quit smoking one the first day of the second week of varenicline treatment.

The current study looked at whether a longer period of pre-quit date varenicline treatment, during which the smoker continues to smoke, increases success is quitting smoking after the quit date. And in fact that is what the study found. Patients who took varenicline for 4 weeks prior to their quit date reduced their smoking in the pre-quit period more than patients who took placebo for 3 weeks and then varenicline for one week before their quit date (the current standard approach). More importantly, the patients who took varenicline for 4 weeks pre-quit date had higher rates of quitting smoking at 12 weeks after their quit date (47% of patients taking varenicline for 4 weeks pre-quit date had quit 12 weeks post-quit date compared to 21% of patients using the standard therapy i.e. one week of varencline pre-quit date). Success rates were highest for patients who took varenicline for 4 weeks pre-quit date and reduced their smoking by more than 50% pre-quit date: 67% of these patients were quit at week 12).

If these findings can be confirmed they will have important implications for helping patients quit smoking. At a basic level, it makes sense that people would be more successful in quitting when they smoke less at the time of their quit date and pre-quit date treatment may help smokers reduce their smoking prior to attempting to quit. Also, smoking on top of varenicline pre-quit date may also help to break the habit of smoking as varenicline blocks the nicotine receptor and as a result reduces the rewarding effects of smoking. Regardless of the mechanism, the study shows how there is still work to be done to find the most optimal way to use medications for smoking cessation as well as other addictions. Initial clinical trials can prove that a medication has a clinical effect. But over time, doctors, researchers, and patients must work to find the optimal treatment regimens that achieve the greatest success for the most people.

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