Combining Varenicline and Bupropion for Smoking Cessation
Condition: Smoking Cessation
Study type: Interventional
Phase: Phase 3

Summary: 
      The goal of this clinical research study is learn if the combination of Chantix (varenicline)
      and Zyban (bupropion) is more effective at helping people to quit smoking than varenicline
      when given alone. Researchers also want to learn if this drug combination can reduce cravings
      and other negative symptoms of nicotine withdrawal better than varenicline does alone. The
      safety of this drug combination will also be tested.
    

Detailed description: 
      The Study Drugs:

      Bupropion and varenicline are designed to imitate the effects that nicotine has on the body.
      This may reduce cigarette cravings and help patients quit smoking.

      Study Groups:

      If you are found to be eligible to take part in this study, you will be randomly assigned (as
      in the roll of a dice) to 1 of 3 treatment groups.

        -  If you are in Group 1, you will receive varenicline and bupropion.

        -  If you are in Group 2, you will receive varenicline and a placebo. A placebo is a
           substance that looks like the study drug (in this case, bupropion) but that has no
           active ingredients.

        -  If you are in Group 3, you will receive a placebo that looks like varenicline and a
           placebo that looks like bupropion.

      You will have a higher chance (5 out of 6) of receiving study drug than receiving just
      placebo. Equal numbers of patients will be in Groups 1 and 2. Neither you nor the study
      doctor will know to which group you are assigned. However, if needed for your safety, the
      study staff will be able to find out which study drug you are receiving.

      Study Drug Administration:

      You will begin taking the study drugs/placebo 1 to 10 days after the first study visit. A
      dose of the study drug/placebo combination will be made up of 1 tablet of varenicline or
      placebo and 1 tablet of bupropion or placebo. You should take each dose of study
      drugs/placebo with a cup (8 oz.) of water after eating a full meal.

      On Days 1-3, you will take 1 dose of the study drug/placebo combination in the morning.

      Beginning on Day 4, and then every day after that, you will take 1 dose in the morning and 1
      dose in the evening (for a total of 2 doses of the study drug/placebo combination each day).
      You must return any study drug bottles as well as any unused study drug to a study staff
      member at each study visit.

      You will be given a smoking diary to record how many cigarettes you smoke (if any) each day
      while you are on study. You must turn in this diary at each study visit.

      Study Visits:

      About 1 time each week while you are taking the study drugs/placebo, the following tests and
      procedures will be performed:

        -  Your weight and blood pressure will be measured.

        -  Your CO level will be measured.

        -  You will be asked about any other drugs you may be taking and about any side effects you
           may be having.

        -  You will answer 8 questionnaires about several topics, including depression, suicide,
           your smoking behavior, any effects from the study drugs, and any symptoms of
           attention-deficit hyperactivity disorder (ADHD). These should take about 30-45 minutes
           total to complete.

        -  You will do tasks that will measure your logic and attention. These will take about 15
           -20 minutes to complete.

        -  You will receive counseling about quitting smoking in which you discuss possible
           "triggers" for smoking and strategies for dealing with quitting smoking. These sessions
           will take about 15 minutes each time.

      During counseling at the first study visit, you will set a "quit date" for stopping smoking
      for about 1 week after you start taking the study drug. You should not quit smoking before
      the quit date. You should stay smoke-free after the quit date. Additionally, you will be
      given a medication instruction sheet, a card with emergency contact information, and a
      participant manual to help you follow along with the topics discussed during counseling.

      At Week 2, saliva will be collected to check your cotinine level.

      At Week 4, blood (about 2 teaspoons) will be drawn to assess liver and kidney function.

      Lab Sessions:

      You may be asked to take part in lab sessions during Visits 1, 2, and 6 to test your brain
      activity and attention span. You will be asked to watch slides and listen to a series of
      tones. The slides will include pictures of people, nature, and artwork. Slides showing nude
      people, medical procedures, and victims of car crashes will also be shown. You will be shown
      examples of these slides before beginning the procedure and given the opportunity to withdraw
      from the study.

      During the lab sessions, your brain electrical activity (EEG) will be monitored. To do this,
      small sensors will be placed on your scalp and face. You should not drink more than 2 cups of
      coffee or other caffeinated drinks for at least 2.5 hours before each session. At the first
      lab session, you may be asked to smoke a cigarette if the doctor thinks it is needed for you
      to exhibit your normal smoking behavior.

      Length of Study:

      You will receive the study drug for up to 12 weeks. However, the entire length of the study
      is about 13 months (55 weeks), which includes 3, 6, and 12-month post-quit follow up visits.
      You will be taken off study if the doctor thinks it is in your best interest.

      End-of-Study Visit:

      After you have finished taking the study drugs/placebo, the following tests and procedures
      will be performed:

        -  Your weight and blood pressure will be measured.

        -  Your CO level will be measured.

        -  You will be asked about any side effects you may be having and about any other drugs you
           may be taking.

        -  Blood (about 2 teaspoons) will be drawn to assess liver and kidney function.

        -  You will answer the same questionnaires you completed at the regular study visits. These
           should take about 30-45 minutes total to complete.

        -  Saliva will be collected to measure your cotinine level.

      Follow-Up Visits:

      About 3, 6, and 12 months after you have stopped smoking, the following tests and procedures
      will be performed:

        -  Your weight, heart rate, and blood pressure will be measured.

        -  Your CO level will be measured.

        -  You will be asked about any side effects you may be having and about any other drugs you
           may be taking.

        -  You will answer the same questionnaires you completed at the regular study visits. These
           should take about 30-45 minutes total to complete.

        -  Saliva will be collected to measure your cotinine level.

      You will be called by the study staff 1 day before your quit date, 3 days after your quit
      date, and at Weeks 14, 20, 34, 42, and 48 weeks after your quit date to check on your
      progress in quitting smoking. Each call should take about 10-15 minutes.

      This is an investigational study. Varenicline and bupropion are both FDA approved and
      commercially available to help people stop smoking. The use of the drugs in combination is
      investigational.

      Up to 385 participants will take part in this study. All will be enrolled at MD Anderson.
    

Intervention name(s): Varenicline; Bupropion; Placebo; Counseling/Phone Calls
Intervention type(s): Drug; Drug; Other; Behavioral
Intervention description(s): On Days 1-3, .5mg tablet by mouth in the morning. Beginning on Day 4, and then every day after that, .5mg tablet by mouth in the morning and .5mg tablet by mouth in the evening (for a total of 2 doses).; On Days 1-3, 150 mg tablet by mouth in the morning. Beginning on Day 4, and then every day after that, 150 mg tablet by mouth in the morning and 150 mg tablet by mouth in the evening (for a total of 2 doses).; On Days 1-3, 1 tablet by mouth of placebo that looks like the study drug in the morning. Beginning on Day 4, and then every day after that, 1 tablet by mouth in the morning and 1 tablet by mouth in the evening for a total of 2 doses of the placebo each day.; Brief-behavioral counseling sessions (10-15 minutes) provided to all participants once per week for 12 weeks. One support phone call conducted 3 days after the target quit date.
Other intervention name(s): Chantix; Zyban
Intervention MeSH terms: Bupropion; Varenicline
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Treatment
Keywords: Smoking Cessation; Nicotine Withdrawal; Smoking Reduction; Varenicline; Chantix; Bupropion; Zyban