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Combining varenicline with nicotine patch boosts quit rates

Quitters more likely not to be smoking at six months with combination than with varenicline alone

Ingrid Torjesen

Wednesday, 09 July 2014

Combining the smoking cessation medication varenicline with nicotine replacement therapy has been found to achieve better long-term quit rates than varenicline alone, a study* in published in JAMA has shown.

Researchers in South Africa randomly assigned 446 generally healthy smokers to nicotine or placebo patch treatment two weeks before a target quit date (TQD) and smokers continued to use the patches for an additional 12 weeks. Varenicline was begun one week prior to the quit date, and was also continued for a further 12 weeks, and tapered off during week 13.

Quitters who received active NRT and varenicline were more likely to achieve continuous abstinence from smoking (confirmed by exhaled carbon monoxide measurements) at 12 weeks (55.4 per cent vs 40.9 per cent) and 24 weeks (49.0 per cent vs 32.6 per cent) and point prevalence abstinence (a measure of abstinence based on behaviour at a particular point in time) at six months (65.1 per cent vs 46.7 per cent) than those receiving varenicline and placebo NRT.

However, there were more side-effects reported in the combination treatment group. More nausea, sleep disturbance, skin reactions, constipation, and depression were reported by quitters using both varenicline and active NRT patches, but only skin reactions were statistically significant (14.4 per cent vs 7.8 per cent). The varenicline only group experienced more abnormal dreams and headaches.

Lead researcher, Dr Coenraad Koegelenberg of Stellenbosch University, Cape Town, South Africa, said the study was the largest to date to examine the efficacy and safety of supplementing varenicline treatment with NRT.  "We have found the combination treatment to be associated with a statistically significant and clinically important higher continuous abstinence rate at 12 and 24 weeks, as well as a higher point prevalence abstinence rate at 6 months," he said.

* Koegelenberg C F N, Noor F, Bateman E D, et al. Efficacy of Varenicline Combined With Nicotine Replacement Therapy vs Varenicline Alone for Smoking Cessation. A Randomized Clinical Trial. JAMA. 2014;312(2):155-161. doi:10.1001/jama.2014.7195

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