Combination Bupropion / Varenicline for Smoking Cessation in Male Smokers

Study Overview
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Brief Summary
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Previous results from the investigators' Center have shown that combination treatment with Chantix and Zyban is more successful in helping men quit smoking. The investigators hope to replicate these findings with this study.

Official Title
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Combination Bupropion / Varenicline for Smoking Cessation in Male Smokers

Conditions
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Nicotine Dependence

Intervention / Treatment
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* Drug: Chantix
* Drug: Zyban
* Drug: Nicotine patches


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Have no known serious medical conditions; Male; Are 18-65 years old; Smoke an average of at least 10 cigarettes per day; Have smoked at least one cumulative year; Have an expired air carbon monoxide (CO) reading of at least 10ppm; Able to read and understand English; Express a desire to quit smoking in the next thirty days. Potential subjects must agree to use acceptable contraception. Potential subjects must agree to avoid the following: participation in any other nicotine-related modification strategy outside of this protocol; use of tobacco products other than cigarettes, including pipe tobacco, cigars, e-cigarettes, snuff, and chewing tobacco; use of experimental (investigational) drugs or devices; use of illegal drugs; use of opiate medications. Exclusion Criteria: Hypertension; Hypotension with symptoms; Coronary heart disease; Lifetime history of heart attack; Cardiac rhythm disorder (irregular heart rhythm); Chest pains (unless history, exam, and electrocardiogram (ECG) clearly indicate a non-cardiac source); Cardiac (heart) disorder (including but not limited to valvular heart disease, heart murmur, heart failure); History of skin allergy; Active skin disorder (e.g., psoriasis) within the last five years; Liver or kidney disorder (except kidney stones, gallstones); Gastrointestinal problems or disease other than gastroesophageal reflux or heartburn; Active ulcers in the past 30 days; Currently symptomatic lung disorder/disease (including but not limited to Chronic obstructive pulmonary disease (COPD), emphysema, and asthma); Brain abnormality (including but not limited to stroke, brain tumor, and seizure disorder); Migraine headaches that occur more frequently than once per week; Recent, unexplained fainting spells; Problems giving blood samples; Diabetes treated with insulin; non-insulin treated diabetes (unless glucose is less than 180mg/dcl and HbA1c is less than 7%); Current cancer or treatment for cancer in the past six months (except basal or squamous cell skin cancer); Other major medical condition; Current psychiatric disease (with the exception of anxiety disorders, Obsessive Compulsive Disorder (OCD) and ADHD); Suicidal ideation (within the past 10 years) or lifetime occurrence of attempted suicide; Current depression; Bulimia or anorexia; Use of opiate medications for pain or sleep (non-opiate medication for pain or sleep will be allowed) within the past 14 days; Smoking more than one cigar a month. Alcohol abuse; Significant adverse reaction to nicotine patches, bupropion / Wellbutrin / Zyban or Chantix / varenicline in the past. Current participation or recent participation (in the past 30 days) in another smoking study at our Center or another research facility. Current participation in another research study. Use (within the past 30 days) of: Illegal drugs (or if the urine drug screen is positive for tetrahydrocannabinol (THC), Cocaine, Amphetamine, Opiates, Methamphetamines, phencyclidine (PCP), Benzodiazepines, or Barbiturates), Experimental (investigational) drugs; Psychiatric medications including antidepressants, anti-psychotics or any other medications that are known to affect smoking cessation (e.g. clonidine); Smokeless tobacco (chewing tobacco, snuff), pipes or e-cigarettes; Wellbutrin, bupropion, Zyban, Chantix, varenicline, nicotine replacement therapy or any other smoking cessation aid.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Chantix<br>For the first 3 days after being switched from Nicotine Replacement Therapy (NRT) (occurring at one week after initiation of nicotine patch treatment, one week before the target Quit Day), smokers in this group will receive treatment with Chantix at a dose of 0.5 mg once per day followed by 0.5 mg twice a day for the remaining 4 days of that week. Subsequently, the dose will be 1 mg twice per day, and will remain at that dose for the remainder of the 12-week active treatment duration. | Drug: Chantix<br> <br> * Other names: Varenicline;Drug: Nicotine patches<br>* All participants will receive 21 mg/24 h dose nicotine (nic.) patches for 1 week.<br>* Other names: NRT;|
| Experimental: Chantix + Zyban<br>For the first 3 days after being switched from NRT (occurring at one week after initiation of nicotine patch treatment, one week before the target Quit Day), smokers in this group will receive treatment with Chantix at a dose of 0.5 mg once per day followed by 0.5 mg twice a day for the remaining 4 days of that week plus Zyban at a dose of 150mg once per day. Subsequently, the dose of Chantix will be 1 mg twice per day and the dose of Zyban will be 150 mg twice per day for the remainder of the 12-week active treatment duration. | Drug: Chantix<br> <br> * Other names: Varenicline;Drug: Zyban<br> <br> * Other names: Bupropion;Drug: Nicotine patches<br>* All participants will receive 21 mg/24 h dose nicotine (nic.) patches for 1 week.<br>* Other names: NRT;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants Completing Continuous Four-week Abstinence From Smoking Between the 8-week and 11-week Post Quit Day Visits | This will be determined by a composite of self-report at the 11-week study visit of no smoking between the 8-week and 11-week visits and expired air carbon monoxide (CO) <10 ppm (measured at the 11-week study visit). An intent-to-treat criterion will be used, whereby drop-outs are considered to be non-abstinent. | Period between 8-week and 11-week visits post target Quit Day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants Completing Seven-day Point Abstinence From Smoking at 6 Months Post Quit Day | This will be determined by a self-report of no smoking for the previous seven days when called for 6-month follow-up confirmed by expired air CO. | 6 months post Quit Day | 
| Number of Participants Completing Continuous Abstinence From Smoking Between Quit Day and 11-week Post Quit Day Visit | This will be determined by a composite of self-report of no smoking between study visits at the 1-week, 3-week, 7-week and 11-week post Quit Day study visits and expired air carbon monoxide (CO) <10 ppm (measured at those study visits). An intent-to-treat criterion will be used, whereby drop-outs are considered to be non-abstinent. | Quit Day to 11-week post Quit Day study visit | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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bupropion, Nicotine addiction, Cigarette smoking, Smoking cessation, Zyban, Chantix, Nicotine patches, varenicline