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July 16, 2014
Two Therapies Better Than One for Smoking Cessation
Cape Town, South Africa—The one-two punch of smoking cessation medication and nicotine-replacement therapy was more effective in keeping smokers off cigarettes after 6 months than varenicline alone, according to a new study. Background information in an article, published recently in the Journal of the American Medical Association, notes that combining nicotine replacement therapy (NRT) with varenicline has been a suggested treatment to improve smoking abstinence, but little previous research had measured its effectiveness. Researchers from Stellenbosch University in Cape Town, South Africa, conducted the study in seven centers in South Africa from April 2011 to October 2012. Nearly 450 participants in relatively good health were recruited. Study subjects were randomly assigned to nicotine or placebo patch treatment 2 weeks before a target quit date (TQD) and continued for an additional 12 weeks. Varenicline, meanwhile, was initiated 1 week prior to TQD, continued for a further 12 weeks, and tapered off during week 13. Results indicate that participants who received active NRT and varenicline were more likely to achieve continuous abstinence from smoking, which was confirmed by exhaled carbon monoxide measurements. Overall, 55.4% of participants at 12 weeks and 49% at 24 weeks remained abstinent after getting the combination therapy versus 40.9% and 32.6%, respectively, of those receiving placebo NRT and varenicline. After 6 months, 65.1% of the active combination therapy group was off cigarettes, compared to 46.7% of the placebo NRT group. “The additive efficacy of combining the two drugs is not easily explained, given that both target [alpha-4 beta-2] nicotine receptors. It is possible that neither varenicline nor nicotine fully saturate all [alpha-4 beta-2] nicotine receptors in the brain, leaving room for the action of others. Alternatively, nicotine replacement may bind to different (additional) receptors involved in nicotine dependency. Interestingly, we found no evidence that combination therapy decreased craving for nicotine,” the authors write. Researchers report that more nausea, sleep disturbance, skin reactions, constipation, and depression occurred in the combination group, with only skin reactions reaching statistical significance—14.4% versus 7.8%. The varenicline-only group reported more abnormal dreams and headaches. “In this study, to our knowledge the largest study to date examining 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 six months,” the authors write.
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