Comparison of the effectiveness of varenicline and combination nicotine replacement therapy (NRT) in clinical practice
| Author(s)
Leonie S. Brose, Robert West and John A. Stapleton
| | Presenter(s) |
Leonie Brose Research Associate, National Centre for Smoking Cessation and Training & University College London | Abstract Objective: To compare the effectiveness of varenicline and combination NRT for treating smokers attempting to stop in clinical practice as it is unclear which of the two is more effective.
Patients and Methods: Data from 167,487 treatment episodes in 42 Stop Smoking Services (1.4.2009 to 30.6. 2011) using varenicline or combination NRT. The outcome was carbon-monoxide (CO) validated 4-week quit rates. The analysis also included age, gender, occupational grade, exemption from prescription charges, intervention setting (specialist or other), support (group or other) and year of quit attempt.
Results: Observed quit rates were higher with varenicline (43.5% versus 36.9%), however the effect of the two options varied widely across the services. Demographics and intervention characteristics that are themselves associated with success also predicted varenicline use. After taking these other factors into account, there was a very small advantage for varenicline over combination NRT (OR=1.080, 95% CI=1.003 to 1.163; difference=1.86%, 95% CI=0.07% to 3.67%, p=0.04).
Conclusions: Averaged across stop smoking services, varenicline is marginally more effective than combination NRT. The relative effect varies substantially according to clinical practice and/or the population treated. Demographics and intervention characteristics associated with success also predict varenicline use.
Published in Mayo Clinic Proceedings, 88(3).
| Presenter biography Leonie is a psychologist by training; she completed her PhD in Health Psychology in 2010 and is a Research Associate with the National Centre for Smoking Cessation (NCSCT) and University College London (UCL).
| Source of funding: Grant Support: This study was funded by Cancer Research UK (CR-UK C1417/A7972), the National Centre for Smoking Cessation, and Pfizer.
| Declaration of interest: Leonie Brose is employed by the National Centre for Smoking Cessation. Before 2005,
John Stapleton acted as adviser to the manufacturers of smoking cessation medications, for which he has received remunerations and hospitality, and conducted clinical trials with support from the manufacturers of smoking cessation medications.
Robert West undertakes research and consultancy for companies that develop and manufacture smoking cessation medications (Pfizer, J&J, McNeil, GSK, Nabi,Novartis, and Sanofi-Aventis). He also has a share of a patent for a novel nicotine delivery device and is a trustee of QUIT, a charity that provides stop smoking support.
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