Reduce-to-Quit Approach in Smoking Cessation Using Varenicline Shows Promise

Most tobacco cessation strategies have targeted individuals willing to abstain completely from tobacco use within one month, but many people decline this treatment approach. This randomized controlled trial of a reduce-to-quit approach comparing 24 weeks of varenicline with placebo included 1510 participants from 10 countries. Individuals with suicidality, other severe mental health disorders, and past-year unhealthy alcohol or substance use were excluded. All participants received ≤ 10 minutes of counseling in 18 clinic and 10 telephone sessions. Participants were asked to reduce tobacco use by ≥ 50% by week 4, ≥ 75% by week 8, and quit by week 12. The main outcome was continuous abstinence rate (CAR) during weeks 15–24 of treatment.

• 47% of varenicline recipients (versus 31% of placebo) reduced tobacco use by ≥ 50% at 4 weeks.
• 26% of varenicline recipients (versus 15% of placebo) reduced tobacco use by ≥ 75% at 8 weeks.
• Week 15–24 CAR for varenicline group was 32% versus 7% for placebo group (risk difference [RD], 25%).
• Week 21-52 CAR for varenicline group was 27% versus 10% for placebo group (RD, 17%).

Comments:

This study demonstrates that a reduce-to-quit approach using varenicline can be effective. However, the fact that frequent counseling is rarely provided in usual clinical practice may decrease the generalizability of these findings. Comparative effectiveness to a similar strategy with nicotine replacement therapy is not known. Furthermore, the exclusion of participants with past-year unhealthy alcohol or substance use makes the impact in this population unknown.

Hillary Kunins, MD, MPH

Reference:

Ebbert JO, Hughes JR, West RJ, et al. Effect of varenicline on smoking cessation through smoking reduction: a randomized clinical trial. JAMA. 2015;313(7):687–694.