Abstract
The concurrent use of both tobacco and alcohol causes substantial disease and early mortality, and smokers who drink heavily tend to be less successful in smoking cessation than smokers who do not. Although varenicline combined with nicotine replacement therapy for smoking cessation has been examined among smokers who do not drink heavily, this combination treatment has not yet been examined among smokers who drink heavily. To determine whether combined treatment with varenicline tartrate and nicotine patch improves continuous abstinence from cigarette smoking among smokers who drink heavily. This double-blind, placebo-controlled, superiority randomized clinical trial evaluated combined treatment with varenicline and nicotine patch compared with placebo and nicotine patch for smoking cessation (primary outcome) and drinking behavior (secondary outcome) among smokers who drink heavily. The clinical trial was conducted at 2 outpatient sites in Chicago, Illinois, with enrollment from March 26, 2018, to February 14, 2020. The 122 participants were recruited from the community via social media and public transit advertisements and equally randomized to the 2 treatment groups, which were stratified by sex and smoking behavior. Eligible participants smoked between 5 and 30 cigarettes per day and drank heavily (>14 drinks per week for men or >7 drinks per week for women and ≥1 heavy drinking day [defined as >5 drinks per occasion for men or >4 drinks per occasion for women] per month for the past year) and had a desire to quit smoking. Varenicline tartrate, 1.0 mg, twice daily or matching placebo pills twice daily for 12 weeks. Nicotine patch at manufacturer-recommended doses for 10 weeks and brief individual smoking cessation counseling the week before the quit date and on the quit date. The primary outcome was self-reported continuous cigarette abstinence through weeks 9 to 12; abstinence was biochemically confirmed at the week 12 study visit. Secondary outcomes were the frequency of weekly drinking and weekly heavy drinking during the study period. Among 122 participants (mean [SD] age, 44.0 [12.4] years; 67 men [54.9%]), 61 were randomly assigned to receive combined treatment with varenicline and nicotine patch (varenicline group), and 61 were randomly assigned to receive placebo and nicotine patch (placebo group). A total of 54 participants (44.3%) self-identified as Black, 56 (45.9%) as White, and 12 (9.8%) as other races (including American Indian or Alaska Native, Asian, >1 race, and unspecified race). A total of 8 participants (6.6%) self-identified as Hispanic and 114 (93.4%) as non-Hispanic ethnicity. Study retention to 12 weeks was 89%. The intention-to-treat analyses showed higher smoking cessation rates during weeks 9 to 12 in the varenicline group vs the placebo group (27 participants [44.3%] vs 17 participants [27.9%]; odds ratio, 2.20; 95% CI, 1.01-4.80; P = .047) and lower likelihood of relapse throughout treatment in the varenicline group relative to the placebo group (hazard ratio, 0.62; 95% CI, 0.40-0.96; P = .03). Both treatments were well tolerated; however, compared with participants in the placebo group, those in the varenicline group experienced more adverse effects, with 5 participants in the varenicline group discontinuing medication due to adverse effects. In this study, combined treatment with varenicline and nicotine patch was more effective than placebo and nicotine patch for smoking cessation among smokers who drink heavily. The combination treatment had no effect on alcohol consumption, with both groups showing significant reductions. Combination treatment with varenicline and nicotine patch may be a viable option for smokers who drink heavily. ClinicalTrials.gov Identifier: NCT02859142.
Highlights
Tobacco and alcohol use are among the top 3 leading contributors to preventable disease and injury in the US and cause significant public health and economic burdens.[1-3]
Meaning This study found that combined treatment with varenicline and nicotine patch improved smoking cessation outcomes among smokers who drink heavily, a population who have historically experienced worse outcomes with standard approved treatments for tobacco cessation
In this study, combined treatment with varenicline and nicotine patch was more effective than placebo and nicotine patch for smoking cessation among smokers who drink heavily
Summary
Tobacco and alcohol use are among the top 3 leading contributors to preventable disease and injury in the US and cause significant public health and economic burdens.[1-3]. One potential candidate for targeting both alcohol and smoking behaviors is varenicline tartrate, a highly effective pharmacotherapy approved for smoking cessation.[12,13]. Varenicline may improve smoking cessation rates among smokers who drink heavily because it acts on neuronal nicotinic acetylcholine receptors that play an important role in the reinforcing effects of both alcohol and nicotine.[14-16]. Varenicline is not an approved medication for alcohol use disorder (AUD),[17] it has been shown to modify acute alcohol responses[18,19] and reduce consumption levels.[20,21]. These effects may be important for smokers who drink heavily because they regularly drink to intoxication, which increases smoking urges[22] and smoking lapses.[23,24]. Varenicline is not an approved medication for alcohol use disorder (AUD),[17] it has been shown to modify acute alcohol responses[18,19] and reduce consumption levels.[20,21] These effects may be important for smokers who drink heavily because they regularly drink to intoxication, which increases smoking urges[22] and smoking lapses.[23,24] varenicline therapy may be effective for smokers who drink heavily because of possible shared neurochemical mechanisms and because alcohol and tobacco facilitate each other
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
