Combo Approach May Work Best for Smokers Looking to Quit

Study finds drug Chantix plus nicotine patch beats use of the patch alone

By Randy Dotinga
HealthDay Reporter

TUESDAY, July 8, 2014 (HealthDay News) -- Combining two anti-smoking approaches -- the medication Chantix and nicotine patches -- improves the odds you'll quit smoking over the short term, a new industry-funded study suggests.

"The combination appears to be safe, although further studies are needed to confirm this," said Dr. Coenie Koegelenberg, an associate professor of pulmonology with Stellenbosch University and Tygerberg Academic Hospital in South Africa.

Although the dual treatment costs more than either agent separately, Koegelenberg said the drugs typically aren't used for long and will reduce overall health costs if smokers succeed in quitting.

Chantix, known by the generic name varenicline, appears to help people stop smoking by interfering with the way that nicotine stimulates the brain.

However, smokers who take Chantix may be at higher risk for heart attacks and stroke compared to those who don't take it, the U.S. Food and Drug Administration said in 2012. But the increased risk is small and should be weighed against the risks of continuing to smoke, the agency said.

Nicotine patches deliver less nicotine -- the addictive element in cigarettes -- than smokers receive from cigarettes. This helps reduce withdrawal symptoms while trying to quit.

While the study found the combination treatment more effective than using nicotine patches alone, it's not a silver bullet. More than one-third of the 400-plus participants were still smoking six months after starting the dual treatment.

Combining Chantix and nicotine patches had been suggested before but it wasn't clear if this approach would be effective and safe.

The current study, published in the July 9 issue of the Journal of the American Medical Association, was funded by Pfizer and McNeil, makers of Chantix and nicotine patches.

Researchers randomly assigned 446 smokers -- mostly women -- to take Chantix and a nicotine patch or the patch with a placebo. Treatment continued for 14 weeks.

At 12 weeks, 55 percent of those who took both medications had continuously stopped smoking compared to 41 percent of those who got the placebo. After six months, the numbers were 49 percent and 33 percent, respectively.

In terms of side effects, the group getting both treatments reported more nausea, sleeplessness, skin reactions, constipation and depression than those using the patch alone. But the researchers said only skin reactions were statistically significant -- 14 percent in the double-treatment group versus 8 percent in the placebo group.

According to Pfizer, Chantix costs $1.53-$6.39 a day, depending on insurance. Nicotine patches average less than $4 a day, according to the National Cancer Institute. Insurance companies often cover anti-smoking medications.

It's not clear why the medications might work better together, Koegelenberg said, but it might have something to do with how they combine to disrupt the way the brain processes nicotine.

Dr. Michael Siegel, a professor with the department of community health sciences at Boston University School of Public Health, said the study is useful because smokers typically are treated with nicotine therapy (a patch or gum) or Chantix, not both.

"It provides some of the first information about the potential effectiveness of combining Chantix and nicotine replacement therapy," he said.

In the big picture, however, quitting smoking remains very difficult even with the help of medications. "Clearly, we need more effective treatment," he said.

Siegel cautioned against deciding to combine Chantix with patches or gum "based solely on this one study. But it is certainly worthy of further study," he added.

More information

For more about quitting smoking, visit the American Cancer Society (http://www.cancer.org/%20healthy/stayawayfromtobacco/guidetoquittingsmoking/index ).

SOURCES: Coenie Koegelenberg, M.D., Ph.D., associate professor, pulmonology, Stellenbosch University and Tygerberg Academic Hospital, Tygerberg, South Africa; Michael Siegel, M.D., M.P.H., professor, Department of Community Health Sciences, Boston University School of Public Health, Boston, Mass.; July 9, 2014, Journal of the American Medical Association

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