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 Smokers who took the pill, sold as Chantix in the U.S. and Champix
elsewhere, were much more likely to quit after cutting back on
cigarettes than smokers who didn’t use the drug, the study found.
"This allows us to reach a much broader population of smokers who
aren't willing to quit abruptly or set a quit date, and it shows
that people can quit without going cold turkey," said lead study
author Dr. Jon Ebbert, a professor in primary care and internal
medicine at the Mayo Clinic in Rochester, Minnesota. "This is very
strong support for changing clinical practice to include gradual
reduction aided by medication."
Smoking is the leading cause of preventable death in the U.S.,
according to the Centers for Disease Control and Prevention. And
tobacco kills one in 10 people worldwide, according to the World
Health Organization.
Quitting can reduce the risk of heart attacks, strokes, and cancers
of the mouth, throat, esophagus and bladder. Ten years after
quitting, the risk of lung cancer drops by half, according to the
CDC.
To see if Chantix, which is manufactured by Pfizer, could help
smokers quit without going cold turkey, Ebbert and colleagues
randomly assigned 1,510 people at 61 centers in 10 countries to
receive either the drug or a placebo for 24 weeks.
They asked study participants to reduce cigarette use by 50 percent
by the fourth week, and by 75 percent by the eight week, with the
goal of quitting by week 12.
By the last ten weeks of treatment, weeks 15 to 24, the group taking
the pill had significantly higher abstinence rates than the group on
placebo.
This held true even after treatment stopped. For weeks 21 through 52
of the study, 27 percent of the people who had previously taken the
drug successfully avoided smoking, compared with less than 10
percent of those who received the placebo.
“This is the first study of its kind to enroll a group of smokers
who are not traditionally enrolled in clinical trials because they
are not ready to quit,” said Dr. Caryn Lerman, professor of
psychiatry and deputy director of the Abramson Cancer Center at the
University of Pennsylvania in Philadelphia.
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“It offers compelling evidence that gradual reduction should be
considered to facilitate quitting,” she said.
But even though the approach helped some hard-to-reach smokers, the
majority of them still failed to quit, noted Lerman, who wasn’t
involved in the study. Other treatments, such as nicotine patches
and gum, can also help some smokers cut back gradually, she said.
While the study shows that Chantix, which is known generically as
varenicline, can be effective for some smokers, the group taking the
pill also experienced more side effects such as nausea, abnormal
dreams, insomnia, constipation, vomiting, and weight gain.
Previous research has linked Chantix to side effects including
suicidal thoughts, erratic behavior and drowsiness. The U.S. Food
and Drug Administration placed a black box warning - its most severe
and restrictive warning - on the product in 2009, highlighting the
drug's adverse neuropsychological effects.
People with a history of major depressive or anxiety disorder,
suicidal behavior, panic disorder, post-traumatic stress disorder,
schizophrenia, or psychosis were excluded from the study, published
in the American Medical Association’s journal JAMA.
SOURCE: http://bit.ly/19t0accJAMA,
online February 17, 2015.
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