Extended interactive voice response telephony (IVR) for relapse prevention after smoking cessation using varenicline and IVR: a pilot study

Bonnie Mcnaughton,Quincy-Robyn Young,Amy Graham,Jiri Frohlich

doi:10.1186/1471-2458-13-824

Abstract

BackgroundThere is a significant resumption of smoking following smoking cessation using varenicline. Both smoking cessation medications and counseling have been shown to increase smoking quit rates at one year. Thus, the combination of varenicline and interactive voice response (IVR) telephony followed by extended IVR may further improve smoking cessation rates at one and two years.Methods101 participants were recruited from the community via newspaper advertisement. They attended a group counseling session and were given smoking information booklets from the Canadian Cancer Society.After 12 weeks of varenicline and 9 IVR calls, all participants who had quit smoking were randomized into 2 groups matched by levels of motivation and addiction as per baseline questionnaire score. The intervention group continued to receive bi-weekly IVR support for weeks 13 – 52. The control group no longer received IVR. The primary end-point was self-reported abstinence and exhaled carbon monoxide levels of less than 10 ppm for weeks 12, 52 and 2 years. Data were analyzed by Fisher’s exact test or Wilcoxon rank-sum test.ResultsOf the 101 participants, 44 (43%) had stopped smoking after 12 weeks of varenicline and 9 IVR calls. Of these, 23 (52%) were randomized to receive IVR calls from weeks 13 to 52.At 52 weeks, 26 (59%) participants remained smoke-free. Of the 23 with IVR, 12 (52.2%) stopped smoking compared to 14 of 21 (66.7%) without IVR. At 2 years, 40 of the 44 (90.9%) randomized participants were contacted and 24 of the 44 (54.5%) came in for testing. Fourteen (13% of the original cohort, 30% who were abstinent at 12 weeks and 53% who were abstinent at 52 weeks) remained smoke-free. Five of the 23 (21.7%) randomized to IVR and 9 of the 21 (42.9%) randomized to no IVR remained smoke-free at 2 years.ConclusionsIn this pilot study of an apparently healthy population, extended IVR did not affect abstinence rates. There was no relapse prevention benefit in offering 9 months of continued IVR to subjects who had stopped smoking after receiving 3 months of varenicline and IVR treatment.Trial registrationClinicalTrial.gov: NCT00832806

Highlights

There is a significant resumption of smoking following smoking cessation using varenicline
When administered for 12 weeks, the smoking cessation drug varenicline has been shown to lead to continuous abstinence rates of about 44% during the last 4 weeks of treatment and 22 – 23% at a one-year follow-up [1,2]
The study is a two-arm, randomized pilot study of 2 years duration to determine the effect of 9 months of extended interactive voice response (IVR) on the effectiveness of smoking cessation after an initial 3 months of varenicline and IVR treatment

Summary

Introduction

There is a significant resumption of smoking following smoking cessation using varenicline Both smoking cessation medications and counseling have been shown to increase smoking quit rates at one year. The combination of varenicline and interactive voice response (IVR) telephony followed by extended IVR may further improve smoking cessation rates at one and two years. When administered for 12 weeks, the smoking cessation drug varenicline has been shown to lead to continuous abstinence rates of about 44% during the last 4 weeks of treatment and 22 – 23% at a one-year follow-up [1,2]. While medications can be effective in reducing withdrawal symptoms and improving treatment outcomes, a combination of pharmacotherapy and behavioral counseling is more likely to increase abstinence rates [3]. Cardiac patients have higher rates of smoking cessation after hospital discharge than a general population [4]

Methods

Results

Conclusion