Varenicline Plus Counseling Elevates Smoking Quit Rate

SAN FRANCISCO – Almost a third of 196 patients (61) were smoke free a year after starting 12 weeks of varenicline therapy and having smoking-cessation counseling in a randomized Australian trial. Only 21% (42) of 196 patients given counseling alone stopped smoking.

The varenicline-plus-counseling results are impressive because the study included people who were on antidepressants and those with depression histories, both of whom had been excluded from several earlier studies of varenicline (Chantix), said lead investigator Dr. Brian Smith of the respiratory medicine unit at the Queen Elizabeth Hospital in Woodville, Australia.

But the most important take-home message of the study was its setup, he said at an international conference of the American Thoracic Society.

The participants had all been hospitalized for at least 1 day for cardiac, respiratory, neurologic, or vascular smoking-related complications. Instead of handing them a quit-smoking hotline card as they walked out the door – the general practice in many hospitals – the investigators had them make their initial counseling service call from the bedside table while they were still in the hospital, Dr. Smith said.

"Only about 6% of patients will make that call" from home. "[We took] the opportunity while they were still inpatients – a captive audience, if you like – to use the bedside phone to make the call. Instead of a 6% success rate, [we had a] 100% success rate," he said.

Patients found a friendly counselor on the other end of the line who emphasized the benefits of quitting instead of the dangers of continuing to smoke. Patients could arrange calls for days when they knew they would be particularly stressed. Counselors would call then to "pull them through," Dr. Smith said.

Both groups got the same standard 5A counseling (ask, advise, assess, assist, and arrange). Patients had the option, if they desired, of several calls a week, but that option wasn’t popular. The mean number of phone calls in the varenicline-plus-counseling arm was 3.8, and in the counseling-only arm it was 4.1.

Varenicline was titrated from 0.5 mg daily to 1 mg twice daily, based largely on nausea. Overall, varenicline patients reported more problems with insomnia (5.1% vs. 2.0% in the counseling-alone group), headache (6.1% vs. 1.5%), vomiting (4.1% vs. 0.5%), and abnormal dreams (6.1% vs. 1.0%).

Despite concerns about the drug, the investigators found no evidence of increased cardiovascular or psychiatric problems in the varenicline group.

"The novel thing of our study is [that we] grabbed the opportunity while these patients were in hospital to get them to make the phone call that otherwise [they] would have been reluctant to make. [We got] them over that hump, got the medication going, [and made] sure they were tolerating it well," Dr. Smith said.

Dr. Smith said he had no disclosures. Pfizer, the maker of Chantix, did not fund and was not involved in the trial, he said. Patients covered at least part of the cost of the drug themselves.

SAN FRANCISCO – Almost a third of 196 patients (61) were smoke free a year after starting 12 weeks of varenicline therapy and having smoking-cessation counseling in a randomized Australian trial. Only 21% (42) of 196 patients given counseling alone stopped smoking.

The varenicline-plus-counseling results are impressive because the study included people who were on antidepressants and those with depression histories, both of whom had been excluded from several earlier studies of varenicline (Chantix), said lead investigator Dr. Brian Smith of the respiratory medicine unit at the Queen Elizabeth Hospital in Woodville, Australia.

But the most important take-home message of the study was its setup, he said at an international conference of the American Thoracic Society.

The participants had all been hospitalized for at least 1 day for cardiac, respiratory, neurologic, or vascular smoking-related complications. Instead of handing them a quit-smoking hotline card as they walked out the door – the general practice in many hospitals – the investigators had them make their initial counseling service call from the bedside table while they were still in the hospital, Dr. Smith said.

"Only about 6% of patients will make that call" from home. "[We took] the opportunity while they were still inpatients – a captive audience, if you like – to use the bedside phone to make the call. Instead of a 6% success rate, [we had a] 100% success rate," he said.

Patients found a friendly counselor on the other end of the line who emphasized the benefits of quitting instead of the dangers of continuing to smoke. Patients could arrange calls for days when they knew they would be particularly stressed. Counselors would call then to "pull them through," Dr. Smith said.

Both groups got the same standard 5A counseling (ask, advise, assess, assist, and arrange). Patients had the option, if they desired, of several calls a week, but that option wasn’t popular. The mean number of phone calls in the varenicline-plus-counseling arm was 3.8, and in the counseling-only arm it was 4.1.

Varenicline was titrated from 0.5 mg daily to 1 mg twice daily, based largely on nausea. Overall, varenicline patients reported more problems with insomnia (5.1% vs. 2.0% in the counseling-alone group), headache (6.1% vs. 1.5%), vomiting (4.1% vs. 0.5%), and abnormal dreams (6.1% vs. 1.0%).

Despite concerns about the drug, the investigators found no evidence of increased cardiovascular or psychiatric problems in the varenicline group.

"The novel thing of our study is [that we] grabbed the opportunity while these patients were in hospital to get them to make the phone call that otherwise [they] would have been reluctant to make. [We got] them over that hump, got the medication going, [and made] sure they were tolerating it well," Dr. Smith said.

Dr. Smith said he had no disclosures. Pfizer, the maker of Chantix, did not fund and was not involved in the trial, he said. Patients covered at least part of the cost of the drug themselves.

SAN FRANCISCO – Almost a third of 196 patients (61) were smoke free a year after starting 12 weeks of varenicline therapy and having smoking-cessation counseling in a randomized Australian trial. Only 21% (42) of 196 patients given counseling alone stopped smoking.

The varenicline-plus-counseling results are impressive because the study included people who were on antidepressants and those with depression histories, both of whom had been excluded from several earlier studies of varenicline (Chantix), said lead investigator Dr. Brian Smith of the respiratory medicine unit at the Queen Elizabeth Hospital in Woodville, Australia.

But the most important take-home message of the study was its setup, he said at an international conference of the American Thoracic Society.

The participants had all been hospitalized for at least 1 day for cardiac, respiratory, neurologic, or vascular smoking-related complications. Instead of handing them a quit-smoking hotline card as they walked out the door – the general practice in many hospitals – the investigators had them make their initial counseling service call from the bedside table while they were still in the hospital, Dr. Smith said.

"Only about 6% of patients will make that call" from home. "[We took] the opportunity while they were still inpatients – a captive audience, if you like – to use the bedside phone to make the call. Instead of a 6% success rate, [we had a] 100% success rate," he said.

Patients found a friendly counselor on the other end of the line who emphasized the benefits of quitting instead of the dangers of continuing to smoke. Patients could arrange calls for days when they knew they would be particularly stressed. Counselors would call then to "pull them through," Dr. Smith said.

Both groups got the same standard 5A counseling (ask, advise, assess, assist, and arrange). Patients had the option, if they desired, of several calls a week, but that option wasn’t popular. The mean number of phone calls in the varenicline-plus-counseling arm was 3.8, and in the counseling-only arm it was 4.1.

Varenicline was titrated from 0.5 mg daily to 1 mg twice daily, based largely on nausea. Overall, varenicline patients reported more problems with insomnia (5.1% vs. 2.0% in the counseling-alone group), headache (6.1% vs. 1.5%), vomiting (4.1% vs. 0.5%), and abnormal dreams (6.1% vs. 1.0%).

Despite concerns about the drug, the investigators found no evidence of increased cardiovascular or psychiatric problems in the varenicline group.

"The novel thing of our study is [that we] grabbed the opportunity while these patients were in hospital to get them to make the phone call that otherwise [they] would have been reluctant to make. [We got] them over that hump, got the medication going, [and made] sure they were tolerating it well," Dr. Smith said.

Dr. Smith said he had no disclosures. Pfizer, the maker of Chantix, did not fund and was not involved in the trial, he said. Patients covered at least part of the cost of the drug themselves.