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For smokers who fail their first quit attempt, increasing the dosage of varenicline or CNRT—or switching CNRT to varenicline—markedly improves short-term and 6-month abstinence rates.
Most smokers do not achieve abstinence on their first quit attempt, but a recent study issued in "JAMA" identifies effective follow-up strategies for those who fail initial treatment. Conducted at a Texas tobacco treatment clinic, this randomized clinical trial enrolled 490 adult smokers (210 women, 287 non-Hispanic White, mean age 48.1 years) who smoked an average of 20 cigarettes per day.
Participants were first treated with either varenicline, a prescription smoking cessation medication, or combined nicotine replacement therapy (CNRT), consisting of a 21-mg patch plus 2-mg lozenges. Those who did not achieve smoking cessation at the 6-week mark were randomly allocated again to continue the same regimen, transition to another therapy, or increase their medication dose for the next 6 weeks. All the subjects received weekly brief counseling throughout the study.
(a) Results for CNRT volunteers:
Of 245 CNRT volunteers, 54 achieved abstinence after the first 6 weeks and continued therapy.
(b) Results for varenicline volunteers:
(c) 6-Month Continuous Abstinence:
To sum up, for smokers who do not achieve abstinence after 6 weeks of treatment, tailored adjustments boost success. Nonabstainers initially on CNRT benefit from either a dosage increase or switching to varenicline, while those on varenicline benefit most from escalating the dosage rather than switching therapies. These findings yield clear guidance for clinicians seeking effective rescue strategies for smokers struggling to quit.
JAMA
Smoking Cessation After Initial Treatment Failure With Varenicline or Nicotine Replacement: A Randomized Clinical Trial
Paul M Cinciripini et al.
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