Combination of varenicline and nicotine lozenges was found to increase smoking abstinence

Smokers looking to overcome their addiction may have a new treatment option following the results of a Monash University-led clinical trial which showed that a combination of varenicline and nicotine lozenges significantly improved smoking abstinence compared to Varenicline alone. The work is published in the news JAMA network opened.

Both varenicline and nicotine lozenges (a form of nicotine replacement therapy) are medications commonly used for smoking cessation. Varenicline is the most effective single therapy currently available for smoking cessation.

The trial, entitled “VANISH” (Varenicline and NICotine Replacement Therapy for Hospital-Hospital Smokers), involved 320 adult daily smokers in five Australian public hospitals. It found that participants treated with both varenicline and nicotine lozenges had an 84% greater chance (odds) of quitting smoking when they self-reported their progress during a 12-month follow-up, compared to those who took varenicline alone.

The multi-institutional study was led by Monash’s Center for Medicine Use and Safety (CMUS) within the Monash Institute of Pharmaceutical Sciences, in collaboration with other leading research institutes including Monash University’s School of Public Health and Preventive Medicine, Flinders University and five major Australian research institutes. public tertiary care hospitals, coordinated by Barwon Health.

To the authors’ knowledge, this is the first reported placebo-controlled, randomized clinical trial comparing the efficacy and safety of Varenicline alone versus the combination of Varenicline and nicotine lozenges in hospitalized heavy smokers.

Associate Professor Johnson George, lead author of the study and smoking cessation expert from CMUS, said the fact that participants self-reported that they were abstaining from smoking during both the six- and 12-month follow-ups of the study , combined with the validated safety of the combination treatment, means that smokers who want to quit now have an additional pharmacological treatment option in the form of varenicline and nicotine lozenges.

“The COVID-19 pandemic limited our ability to measure biochemically validated abstinence; however, based on self-reported abstinence, the combination therapy was clearly the more effective option compared to Varenicline alone, without compromising safety,” said Associate Professor George. .

“As such, in the context of heavy smokers who continue to experience withdrawal symptoms when using varenicline alone, based on our findings it is certainly worthwhile to consider incorporating nicotine lozenges into their treatment regimen.”

Smoking is the leading cause of preventable illness and death in Australia. While the number of people smoking tobacco cigarettes has fallen dramatically in recent decades, a new generation of nicotine addiction has simultaneously escalated due to the introduction of e-cigarettes and vaping.

“Vaping is highly addictive and extremely common, especially among teenagers. Whatever your age, vaping has no place as an evidence-based smoking cessation strategy in managing nicotine addiction,” said Associate Professor George.

“Taking this into account, the more alternative options we can offer smokers without vaping, the better.”

The researchers focused on heavy smokers in hospital because they would benefit greatly from quitting smoking, which would also lead to greater benefits for the community and healthcare systems.

“Ideally, the next step would be to conduct large clinical trials to measure biochemically validated abstinence from the combination therapy, including in people with vaping addiction, and also look at a wider range of settings,” concluded Associate Professor George.

The five hospital partners include four Victorian hospitals: Eastern Health, Peninsula Health, Barwon Health, Monash Health and Queen Elizabeth Hospital (Adelaide).