Smoking Cessation: Odds Improved By Combining Chantix With Nicotine Patches

MedicalResearch.com Interview with: Coenie Koegelenberg, MBChB, MMed (Int), FCP (SA), MRCP (UK), Cert Pulm (SA), PhD Associate Professor: Pulmonology Stellenbosch University & Tygerberg Academic Hospital
MedicalResearch.com Interview with:
Coenie Koegelenberg, MBChB, MMed (Int), FCP (SA), MRCP (UK), Cert Pulm (SA), PhD
Associate Professor: Pulmonology
Stellenbosch University & Tygerberg Academic Hospital

Medical Research: What are the main findings of the study?

Dr. Koegelenberg: The aim of this study was to evaluate the efficacy of combining varenicline and a nicotine patch versus varenicline alone as an aid to smoking cessation in a double-blind study design in a larger group and with a longer assessment period than has been studied to date. It was found that the combination treatment was associated with a statistically significant and clinically important higher continuous abstinence rate at 12 weeks (55.4% vs. 40.9%; P=.007) and 24 weeks (49.0% vs. 32.6%; P=.004), and point prevalence abstinence rate at 6 months (65.1% vs. 46.7%; P=.002). The present study was not adequately powered to fully assess safety and tolerability endpoints, but the results suggest that adverse events were balanced across treatment arms, except for mild skin reactions that were more frequently observed in the nicotine patch group (14.4% vs. 7.8%, P=.03).

Medical Research: Were any of the findings unexpected?

Dr. Koegelenberg: Both varenicline and nicotine acts on the nicotinic cholinergic receptor, specifically the α4β2 receptor subtype, which is believed to be the principal mediator of nicotine dependence. The additive efficacy of combining the two drugs therefore cannot be readily explained. It is possible that neither varenicline nor nicotine alone fully saturate all nicotine receptors in the brain, leaving room for the action of the other. Nicotine replacement may also bind to additional receptors involved in nicotine dependency. A further possibility is that the different pharmacokinetics of the two components provides a more favorable onset of receptor agonism. Moreover, it is possible that the introduction of varenicline one week after Nicotine replacement therapy, or tapering of varenicline might in some way have improved the effectiveness of the combination.

Medical Research: What should clinicians and patients take away from your report?

Dr. Koegelenberg: It was shown that in relatively healthy smokers, the odds of achieving successful smoking cessation after 12 and 24 weeks were significantly increased by using a combination of varenicline and nicotine patches compared to varenicline alone. The combination appeared to be safe, although further studies are needed to confirm this.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Koegelenberg: The study population was limited to relatively healthy smokers. Future studies should include a broader range of smokers (including those with significant cardiovascular and/or respiratory diseases), other forms of nicotine replacement therapy and assessments of tolerability and cost/benefit comparisons with alternative therapies.

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