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Varenicline for Smoking Cessation

 

Am Fam Physician. 2017 Sep 1;96(5):online.

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VARENICLINE (CHANTIX) FOR SMOKING CESSATION

BenefitsHarms

1 in 11 stopped smoking

1 in 5 had nausea

1 in 15 had abnormal dreams

1 in 23 had insomnia

1 in 50 had headache

1 in 143 had serious adverse events (infections, cancers, injuries)

VARENICLINE (CHANTIX) FOR SMOKING CESSATION

BenefitsHarms

1 in 11 stopped smoking

1 in 5 had nausea

1 in 15 had abnormal dreams

1 in 23 had insomnia

1 in 50 had headache

1 in 143 had serious adverse events (infections, cancers, injuries)

Details for This Review

Study Population: Adult smokers willing to attempt quitting smoking

Efficacy End Points: Smoking cessation at least six months from the start of intervention

Harm End Points: Medication side effects or adverse events

Narrative: Worldwide, smoking remains the main preventable cause of morbidity and premature death. Dependence on nicotine reflects the effects of the drug on neuronal receptors in the brain, which stimulate the release of dopamine. Varenicline (Chantix) is a medication that aids in smoking cessation by acting as a nicotine receptor partial agonist, and is one of seven first-line medications recommended to increase long-term smoking abstinence.1 The authors of a systematic Cochrane review performed a meta-analysis examining 39 randomized trials (N = 11,801) that tested varenicline in a variety of populations and settings, and against various comparators.2 Trials included in the review variably enrolled adult smokers with the goal of cessation for at least six months.

Varenicline adminstered at the standard dosage (1 mg twice daily) more than doubled the chances of quitting compared with placebo, with a pooled risk ratio [RR] of 2.24 (95% confidence interval [CI], 2.06 to 2.43; 27 trials, N = 12,625; high-quality evidence). Varenicline at a reduced dosage (0.5 mg twice daily) remained effective with an RR of 2.08 (95% CI, 1.56 to 2.78; four trials, N = 1,266), a cessation rate that is similar to varenicline vs. bupropion (Zyban), with an RR of 1.39 (95% CI, 1.25 to 1.54; five trials, N = 5,877; high-quality evidence), and nicotine replacement therapy, with an RR of 1.25 (95% CI, 1.14 to 1.37; eight trials, N = 6,624; moderate-quality evidence). Based on this evidence and using advanced statistical modeling, the authors calculated the number needed to treat (NNT) with varenicline as 11 (95% CI, 9 to 13). Using the compiled data and absolute risk reduction without advanced statistics gives an NNT for varenicline vs. placebo, bupropion, and nicotine replacement therapy of 6, 15, and 20, respectively.

The predominant adverse event was mild to moderate nausea subsiding

REFERENCES

1. Agency for Healthcare Research and Quality. Treating tobacco use and dependence. http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/references/quick-ref/index.html. Accessed July 27, 2017.

2. Cahill K, Lindson-Hawley N, Thomas KH, Fanshawe TR, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2016;(5):CD006103.

3. U.S. Food and Drug Administration. FDA Drug Safety Communication: FDA updates label for stop smoking drug Chantix (varenicline) to include potential alcohol interaction, rare risk of seizures, and studies of side effects on mood, behavior, or thinking. March 9, 2015. https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm169988.htm. Accessed July 27, 2017.

 

 

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