Vaping as Good as Chantix to Help Quit Smoking: JAMA Study

WASHINGTON – E-cigarettes were about as effective at helping people quit smoking as the pharmaceutical drug varenicline, according to a study. clinical trial published Monday in JAMA Internal Medicine.

In the study, 458 people who smoked daily and wanted to quit were randomized to receive either a nicotine-containing e-cigarette and placebo tablets, varenicline and an e-cigarette without nicotine, or a placebo tablet and a nicotine-free e-cigarette for 12 weeks. . All three groups also received intensive guidance on quitting smoking.

After 26 weeks, approximately equal percentages of participants who used varenicline and e-cigarettes – 43.8 percent and 40.4 percent, respectively – had quit smoking. The difference in quit rates between the two groups was not statistically significant.

The JAMA study is the first published randomized controlled trial to directly compare Varenicline, also known as Chantix, with e-cigarettes. Several studies have shown that e-cigarettes can help adults quit smoking. However, most studies have compared e-cigarettes with placebo alone, or with nicotine replacement therapy, such as patches and lozenges, which help smokers manage their withdrawal symptoms.

The lawsuit is likely to cause a stir within the tobacco control community, which is deeply divided over whether e-cigarettes are a help or hindrance to adults who smoke cigarettes, and whether they should be recommended by doctors as a way to smoke cigarettes. to get rid of a smoking habit. While countries like Britain actively encourage smokers to use these products to help them quit smoking, countries like the United States and Japan have been much more conservative. E-cigarette advocates say this research shows Britain has the right idea.

“In this country and elsewhere… public health groups are working hard to limit access to it [e-cigarettes]which is counterproductive to the goal of making more smoking cessation treatment options available to people who smoke,” said Kenneth Michael Cummings, a professor at the Medical University of South Carolina and an outspoken advocate of e-cigarettes as a cessation tool.

Varenicline is considered the most effective treatment for smoking cessation. The pill works mainly by blocking the receptors in the brain that make nicotine pleasurable. However, the drug is associated with sometimes disturbing side effects, including abnormal, vivid dreams and insomnia. Availability of the drug is also irregular, both in the United States and abroad, due to manufacturing problems.

The study was conducted in Finland and led by researchers at Lapland Central Hospital.

Independent researchers who reviewed the study said that while e-cigarettes should not replace varenicline as a first-line treatment, they should be seen as a viable option for smokers trying to quit.

“Varenicline’s long track record of efficacy and safety and its approval by the FDA as a smoking cessation aid favor this agent as a first-line choice, but this study indicates that [e-cigarettes] are certainly an option for people who have not had success with, or cannot tolerate, Varenicline,” said Nancy Rigotti, director of the Tobacco Research and Treatment Center at Massachusetts General Hospital, who was not involved in the study.

Not everyone is convinced that this new study should change America’s approach to e-cigarettes, especially given the outstanding questions about their impact on users’ long-term health.

“The major limitation of the article is that it assumes that e-cigarettes are so much safer than [cigarettes] that the authors need not consider continued use of e-cigarettes as a complication. This is wrong,” said Stanton Glantz, a retired professor at the University of California, San Francisco, who is critical of e-cigarettes.

According to Rigotti, the results of the study also indicate that in the long term, Varenicline may still be more effective at quitting than e-cigarettes. That’s because e-cigarettes did not maintain a statistically significant benefit over placebo during a 52-week follow-up, while varenicline did maintain its benefit. The difference between Varenicline and e-cigarettes after 52 weeks was not statistically significant.

“Because the difference between [e-cigarettes] and Varenicline is not statistically significant (just misses) after one year, the study cannot conclude that Varenicline is better, although it does indicate that [a] This could become apparent from a larger study,” Rigotti explains.

The primary endpoint of the study was abstinence at 26 weeks, not at 52 weeks. The Food and Drug Administration recommends that companies developing smoking cessation treatments assess their impact on smoking for at least four weeks, although an assessment after 26 weeks is generally considered preferable. period for a study to reliably predict long-term cigarette abstinence. For example, the U.S. Preventive Services Task Force, which reviews the evidence underlying various tobacco treatments, rates an intervention’s efficacy based on how well it keeps smokers abstinent for at least six months.

It’s also unclear how the results of the study published Monday would differ if participants were given different types of e-cigarettes. The newly published study used a vape loaded with a relatively low concentration of nicotine, compared to a number of vapes currently available on the US market.

There are reportedly more than 9,000 e-cigarette products on shelves in the United States, varying in nicotine concentration. Research has done that too found it that vapes vary dramatically in how well they deliver nicotine to the user. No e-cigarettes have been approved as a smoking cessation tool in the United States.

The smoking cessation counseling offered to each participant in the new study may also have influenced quit rates. One in five participants who received the placebo drug and device successfully quit smoking after only receiving advice, which the authors say “seems to indicate that repeated [counseling] could help at least some of these confirmed adult smokers quit the habit.”