Intensifying or changing therapy helps heavy smokers quit

For most smokers, their first attempt to quit smoking is likely to be unsuccessful, but a new study conducted at the Cancer Center. M.D. Anderson of the University of Texas, showed that patients were more likely to quit smoking if their smoking cessation program was modified and doses were increased. The researchers also found that varenicline, a smoking cessation drug, was more effective than combination nicotine replacement therapy (CNRT), such as patches or lozenges.

A study published in JAMA found that smokers who failed to quit using varenicline in the first phase of the trial were seven times more likely to quit by the end of the second phase if varenicline doses were increased.

The percentage of those who successfully quit smoking also nearly doubled if they switched from CNRT to varenicline. These results compare favorably with the near-zero chance of abstinence in patients who were switched from varenicline to CRNT or remained on the same treatment plans.

"These data indicate that sticking to the same medication is not effective for smokers who are unable to quit in the first six weeks of treatment," said lead researcher Paul Cinciripini, Ph.D., chair of the Department of Behavioral Sciences.

"Our research should encourage doctors to check in with patients early in their quit journey and, if patients are having difficulty, try a new approach, such as increasing the dose of medication."

The double-blind, placebo-controlled trial followed 490 smokers who were randomized to receive six weeks of varenicline or CNRT. After the first phase, those who failed to quit were re-randomized to continue, change, or increase their medication dose for an additional six weeks.

Initial treatment included 2 mg varenicline or CNRT (21 mg patch plus 2 mg lozenge). Participants who were re-randomized either continued the same dose of varenicline or CNRT, changed from varenicline to CNRT or vice versa, or received an increased dose of 3 mg varenicline or CNRT (42 mg patch plus 2 mg lozenge). The study was conducted in Texas from June 2015 to October 2019.

Of patients who received varenicline and had increased doses, 20% remained abstinent after six weeks. Meanwhile, the abstinence rate was 14% among patients who switched from CNRT to varenicline or whose CNRT doses were increased. However, patients treated with varenicline who switched to CNRT showed a 0% smoking cessation rate. After six months, only those who increased their doses remained continuously abstinent.

Tobacco use remains the leading preventable cause of death and disease in the United States. Every year, about 480,000 Americans die from tobacco-related diseases. Currently, more than 16 million Americans suffer from at least one smoking-related disease, including cancer.

Quitting tobacco use can improve the chances of survival by 30–40% in cancer patients who smoke. Because the average smoker makes several attempts to quit before successfully beating the addiction, MD Anderson addresses barriers to smoking cessation at the individual and population level by considering cost, access to smoking cessation services, and knowledge gaps among health care providers about tobacco treatment dependencies.

In a larger ongoing study, researchers are testing several different drug combinations as an alternative for those who cannot quit smoking on initial doses of varenicline or CNRT.