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Wiener Klinische Wochenschrift May 2019Smoking and second-hand smoke strongly increase incidence of diabetes and probability for its complications. Smoking cessation can lead to weight gain and increased... (Review)
Review
Smoking and second-hand smoke strongly increase incidence of diabetes and probability for its complications. Smoking cessation can lead to weight gain and increased diabetes risk; however, it decreases cardiovascular and total mortality. A basal diagnostics (Fagerström Test, exhaled CO) is the basis for successful smoking cessation. Supporting medication include Varenicline, Nicotine Replacement Therapy and Bupropion. Socio-economic as well as psychological factors play an important role for smoking and smoking cessation.Moderate consumption of alcohol possibly decreases risk for diabetes and cardiovascular diseases. Selection bias and underreporting in studies maybe contribute to a too optimistic view. On the other hand, alcohol increases in a dose dependant fashion excess morbidity and disability adjusted life years, especially by cancer, liver diseases and infections.
Topics: Alcohol Drinking; Benzazepines; Bupropion; Diabetes Mellitus; Humans; Nicotine; Practice Guidelines as Topic; Quinoxalines; Smoking; Smoking Cessation; Tobacco Use Cessation Devices; Varenicline
PubMed: 30980165
DOI: 10.1007/s00508-019-1455-z -
The American Journal of Drug and... Mar 2016Tobacco is the leading cause of preventable death in the world. Current cessation medications include nicotine replacement therapy (NRT), varenicline, and bupropion,... (Review)
Review
BACKGROUND
Tobacco is the leading cause of preventable death in the world. Current cessation medications include nicotine replacement therapy (NRT), varenicline, and bupropion, while combination therapy primarily entails NRT with either varenicline or bupropion. However, recent studies have examined varenicline and bupropion in combination.
OBJECTIVES
A systematic review assessing the efficacy and safety of combination varenicline and bupropion was conducted.
METHODS
PubMed and Clinicaltrials.gov were searched using terms: "varenicline combination", "bupropion combination", "bupropion AND varenicline", and "bupropion AND varenicline combination smoking cessation", yielding four studies including 1193 total patients.
RESULTS
Combination therapy yielded greater efficacy than varenicline monotherapy in two randomized controlled trials and one retrospective outcomes study. One single-arm Phase II trial provided additional efficacy and safety data. Of the prospective trials, one displayed a greater 4-week smoking abstinence for weeks 8-11 with combination (39.8%) versus monotherapy (25.9%) (OR = 1.89; 95% CI = 1.07-3.35). The other demonstrated greater prolonged abstinence (continuous abstinence from week 2) at 12 weeks (OR = 1.49; 95% CI = 1.05-2.12) and 26 weeks (OR = 1.52; 95% CI = 1.04-2.22), though results were not significant at 52 weeks in this study. The retrospective study displayed higher success rates (continuous abstinence rates at 52 weeks) with combination varenicline and bupropion (55.0%; compared to varenicline monotherapy (32.1%), p < 0.001). Subgroup analyses suggest that this combination may be more beneficial in males and patients with higher baseline nicotine dependence.
CONCLUSION
To the authors' knowledge, this is the first review conducted to compile current literature on this novel pharmacotherapy combination for smoking cessation. Combination bupropion SR and varenicline displayed greater efficacy in smoking cessation than varenicline monotherapy, though further safety analysis is warranted to rule out additive psychiatric adverse effects.
Topics: Bupropion; Delayed-Action Preparations; Drug Therapy, Combination; Humans; Smoking Cessation; Varenicline
PubMed: 26809272
DOI: 10.3109/00952990.2015.1117480 -
Praxis Nov 2016
Comparative Study Randomized Controlled Trial
Topics: Adolescent; Adult; Aged; Anxiety Disorders; Bupropion; Cohort Studies; Comorbidity; Double-Blind Method; Female; Humans; Male; Middle Aged; Mood Disorders; Nicotine; Smoking Cessation; Varenicline; Young Adult
PubMed: 27911663
DOI: 10.1024/1661-8157/a002545 -
Journal of Addiction MedicineVarenicline is a partial agonist at the α2β4 and α6β2 nAChR receptors and a full agonist at α7 receptors. Both α7 and α6β2 receptors are implicated in the neural...
OBJECTIVES
Varenicline is a partial agonist at the α2β4 and α6β2 nAChR receptors and a full agonist at α7 receptors. Both α7 and α6β2 receptors are implicated in the neural reward circuitry activated by cocaine use. A preliminary clinical trial suggested that varenicline treatment reduced cocaine use. This trial was intended to replicate and extend the findings of the previous trial.
METHODS
This was a 12-week, double-blind, placebo-controlled clinical trial involving 156 subjects with DSM IV cocaine dependence. Subjects received up to 2 mg of varenicline or identical placebo daily along with weekly relapse prevention psychotherapy. The primary outcome measure was cocaine use measured by thrice-weekly urine drug screens. Additional outcome measures included end of study cocaine abstinence, cocaine craving, cocaine withdrawal symptom severity, cigarette use, and global improvement measure by the Clinical Global Improvement Scale.
RESULTS
End of study cocaine abstinence, measured by urine drug screens during the last 3 weeks of the trial, was not different between groups (8% in the varenicline treated subjects and versus 9% in placebo-treated subjects). Generalized estimating equations analysis of urine drug screen results showed no significant difference between groups in cocaine abstinence over the 12 weeks of the trial. There were no significant differences between the 2 groups in cocaine craving or cocaine withdrawal symptom severity. Varenicline was well-tolerated. There were no medication-associated serious adverse events.
CONCLUSIONS
Varenicline plus cognitive-behavioral therapy does not seem to be an efficacious treatment for cocaine dependence.
Topics: Cocaine-Related Disorders; Double-Blind Method; Humans; Nicotinic Agonists; Treatment Outcome; Varenicline
PubMed: 33840773
DOI: 10.1097/ADM.0000000000000842 -
CMAJ : Canadian Medical Association... Dec 2016
Review
Topics: Aftercare; Behavior Therapy; Bupropion; Canada; Dopamine Uptake Inhibitors; Humans; Motivation; Nicotinic Agonists; Smoking; Smoking Cessation; Tobacco Use Cessation Devices; Tobacco Use Disorder; Varenicline
PubMed: 27698200
DOI: 10.1503/cmaj.151510 -
Journal of the American Pharmacists... 2023Smoking is the leading preventable cause of illness and premature death worldwide. Most tobacco users desire to quit, but few are successful. Guidelines recommend... (Review)
Review
BACKGROUND
Smoking is the leading preventable cause of illness and premature death worldwide. Most tobacco users desire to quit, but few are successful. Guidelines recommend varenicline as an initial treatment recommendation to support smoking cessation.
OBJECTIVES
Determine whether historic warnings preclude the use of varenicline as an initial treatment recommendation in patients with and without certain comorbidities. Appendix 1 shows the questions asked in the survey.
METHODS
This study was conducted in 2 parts. Part 1 of this study was a provider survey. Part 2 was a multicenter, retrospective chart review. Survey respondents were primary care providers (PCPs) or internal medicine residents within a large health system. Patients included in the chart review had a PCP appointment between January 1, 2017, and December 31, 2020, and a diagnosis of tobacco dependence or tobacco cessation therapy prescription.
RESULTS
In total, 352 providers were included in survey distribution and 56 responses were received, resulting in a response rate of 16%. Most providers (77%) indicated that they would be likely to use varenicline as an initial treatment recommendation in a patient with no comorbidities. Providers indicated they would be unlikely to use varenicline in a patient with certain mental health comorbidities (43%, 43%, and 55% for patients with bipolar disorder, schizophrenia, or history of suicide attempts, respectively, with 25%, 30%, and 27% having no opinion for each group). In addition, chart review yielded data for 25,128 patients. Notably, patients with schizophrenia were found to have an odds ratio of 0.55 (95% confidence interval [CI] 0.39-0.77) to receive varenicline at any point in therapy, and patients with diabetes had an odds ratio of 2.66 (95% CI 2.22-3.19) to receive no treatment.
CONCLUSIONS
Historic warnings for neuropsychiatric events with varenicline may still preclude usage in patients with serious psychiatric comorbidities such as schizophrenia. In addition, patients with diabetes were less likely to receive any form of tobacco cessation therapy.
Topics: Humans; Varenicline; Nicotinic Agonists; Retrospective Studies; Smoking Cessation; Smoking; Multicenter Studies as Topic
PubMed: 36925391
DOI: 10.1016/j.japh.2023.01.010 -
Revue de Pneumologie Clinique Jun 2018Smoking cessation treatments have been proved effective to stop smoking. For pharmacological treatments, nicotine replacement therapies (NRT) as well as bupropion allow... (Review)
Review
Smoking cessation treatments have been proved effective to stop smoking. For pharmacological treatments, nicotine replacement therapies (NRT) as well as bupropion allow to increase 6 month-abstinence rates by more than 80% in comparison with placebo while varenicline prescription doubles success rates in the same conditions. These results mean that for 10 smokers who quit with placebo, 18 are expected to quit with NRT or bupropion and 28 are expected to quit with varenicline. Varenicline is 50% more effective than nicotine patch and 70% more effective than nicotine gum. Nevertheless, a combination including NRT patch and oral nicotine forms is as effective as varenicline, thus leading to encourage the prescription of a combination NRT when NRT are chosen. For these three pharmacological treatments, cardiovascular as well as neuropsychiatric tolerance were not found statistically different from placebo in randomized controlled trials. Yet, bupropion prescription leads to an increasing risk of seizure (1/1000 to 1/1500). For behavioral treatment, motivational interviewing as well as cognitive behavior therapies are been proven to be effective to stop smoking but few smokers have access to this treatment. Smoking cessation mobile application and smartphone application seem to be promising in terms of effectiveness and might be useful to reach more smokers.
Topics: Bupropion; History, 21st Century; Humans; Nicotine; Smoking Cessation; Tobacco Use Cessation Devices; Varenicline
PubMed: 29650283
DOI: 10.1016/j.pneumo.2018.03.004 -
Nicotine & Tobacco Research : Official... Jan 2023Waterpipe smoking is increasing worldwide with no proven interventions for cessation. We compared abstinence rates with 12-week varenicline therapy versus placebo among... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Waterpipe smoking is increasing worldwide with no proven interventions for cessation. We compared abstinence rates with 12-week varenicline therapy versus placebo among habitual waterpipe smokers willing to quit.
METHODS
This double-blind placebo-controlled single-center trial, randomized waterpipe smokers from Lebanon who did not smoke other tobacco products to receive varenicline or placebo for 12 weeks. All participants also received three structured 30-minute individual behavioral intervention sessions. The primary outcome was repeated point prevalence abstinence assessed by self-report and verified by exhaled carbon monoxide three times during 12 weeks and analyzed with the intention to treat. End of treatment urine cotinine, weight, blood pressure, anxiety, depression, withdrawal, and adverse symptoms were also assessed.
RESULTS
In total, 152 waterpipe smokers (mean age 38 years [SD = 13], 39% females) willing to quit, who smoked waterpipe exclusively (average 2.3 per day [SD = 1.6] for 16.8 years [SD = 10.8]) were randomized. Seventy-nine participants (52%) with any missing abstinence assessment were considered to have relapsed. Repeat point prevalence abstinence rate was numerically higher among the varenicline group compared to placebo, but the difference did not reach statistical significance when assessed by self-report (16.9 vs. 13.6%, respectively, p = .6) and when further verified by exhaled carbon monoxide (14.1% vs. 9.9%, respectively, p = .4). Abstinence rates were similar in both groups when further verified by urine cotinine at end of treatment. No serious adverse events were reported, adverse symptoms and other outcomes were similar in the varenicline and placebo arms.
CONCLUSIONS
Varenicline for 12 weeks was not more effective than placebo to achieve abstinence among daily waterpipe smokers.
IMPLICATIONS
Varenicline in combination with a behavioral intervention did not significantly enhance the quit rate among exclusive waterpipe smokers compared to behavioral intervention plus placebo. We experienced difficulty enrolling exclusive waterpipe smokers willing to quit and observed high dropout rates among participants demonstrating the difficulties of waterpipe smoking cessation.
Topics: Female; Humans; Adult; Male; Varenicline; Smoking Cessation; Water Pipe Smoking; Carbon Monoxide; Cotinine; Nicotinic Agonists
PubMed: 35789389
DOI: 10.1093/ntr/ntac162 -
Addiction (Abingdon, England) Sep 2016To determine the effectiveness and safety of varenicline in treating tobacco dependence in patients with severe mental illness. (Meta-Analysis)
Meta-Analysis Review
AIMS
To determine the effectiveness and safety of varenicline in treating tobacco dependence in patients with severe mental illness.
DESIGN
A systematic review and meta-analysis of randomised controlled trials that compared varenicline with a placebo or an alternative intervention for smoking cessation or reduction.
SETTING
Both in- and out-patient settings in any country.
PARTICIPANTS
Adult patients aged 18 years and over with any type of severe mental illness. The systematic review included eight studies comprising 398 participants.
MEASURES
Primary outcome measures were (1) smoking cessation, (2) smoking reduction measured by changes in the number of cigarettes smoked per day and (3) number of psychiatric adverse events, which were collected at the end of treatment.
FINDINGS
The random-effect pooled estimates from the five studies that reported smoking-related outcomes found that varenicline is statistically superior to placebo in smoking cessation [risk ratios 4.33; 95% confidence interval (CI) = 1.96-9.56], and smoking reduction was higher in varenicline groups (mean reduced daily cigarettes was 6.39; 95% CI = 2.22-10.56). There is no significant difference regarding neuropsychiatric and other adverse events.
CONCLUSIONS
Varenicline appears to be significantly more effective than placebo in assisting with smoking cessation and reduction in people with severe mental illness. There appears to be no clear evidence that varenicline was associated with an increased risk of neuropsychiatric or other adverse events compared with placebo.
Topics: Comorbidity; Humans; Mental Disorders; Nicotinic Agonists; Smoking; Smoking Cessation; Tobacco Smoking; Varenicline
PubMed: 27043328
DOI: 10.1111/add.13415 -
The Medical Letter on Drugs and... Jul 2019
Review
Topics: Bupropion; Humans; Randomized Controlled Trials as Topic; Smoking Cessation; Smoking Cessation Agents; Tobacco Use Cessation Devices; Varenicline
PubMed: 31381546
DOI: No ID Found