Efficacy of Varenicline for Smokeless Tobacco Use in India

Study Overview
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Brief Summary
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This study, based in India, is testing the efficacy of varenicline to help smokeless tobacco users with cessation efforts.

Detailed Description
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The prevalence of smokeless tobacco use in the United States is low vs. cigarette smoking, yet rates have remained constant over the past few years. In contrast, the rate of smokeless tobacco use in India is 20%. Smokeless tobacco is a carcinogenic and responsible for  10,000 deaths/year from oral cancer in India. Unfortunately, there have been remarkably few intervention trials in India for smokeless tobacco users. To date, no trial has evaluated the new FDA approved medication, varenicline, for smokeless tobacco use. We will conduct a randomized placebo-controlled trial of varenicline for smokeless tobacco dependence at the National Drug Dependence Treatment Center (NDDTC) at the All India Institute of Medicine (AIIMS) in New Delhi with 237 smokeless tobacco users. The primary aims of this trial are to: 1) enhance research capacity at the NDDTC (i.e., train AIIMS staff to implement the behavioral counseling protocol with pharmacotherapy, data collection and management procedures); 2) assess the efficacy of varenicline for increasing biochemically confirmed 7-day point prevalence smokeless tobacco quit rates at the end-of treatment; and 3) assess longitudinal patterns of relapse and recovery following treatment with varenicline. The results of this trial may guide future investments to evaluate the efficacy of varenicline for smokeless tobacco dependence in the US, which is critical since smokeless tobacco use in the US may increase in the coming years and no approved pharmacotherapy for this drug dependence exists in the US or around the globe.

Official Title
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Efficacy of Varenicline for Smokeless Tobacco Use in India

Conditions
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Tobacco Use Disorder

Intervention / Treatment
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* Drug: Varenicline
* Behavioral: Counseling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: males and females over age 18 used smokeless tobacco every day for the past year (confirmed with urinary cotinine) residing within 100km of New Dehli for the next 4 months interested in quitting use of smokeless tobacco. Exclusion Criteria: currently enrolled or plan to enroll in another tobacco cessation program in the next 4 months plan to use other smoking cessation treatments in the next 4 months smoke cigarettes have current substance abuse (e.g., opioids, cocaine, marijuana) verified by urine drug screen have current (last 6-months) alcohol consumption that exceeds 25 standard drinks/week (if past abuse, must be symptom free for ≥ the past 12 months) Current use or discontinuation within last 14 days of: smoking cessation medications (bupropion, Varenicline, NRT); antipsychotics, atypicals, mood-stabilizers, anti-depressants (tricyclics, SSRIs, MAOIs), anti-panic agents, anti-obsessive agents, anti-anxiety agents, stimulants; Anti-coagulants; Daily medication for asthma or diabetes (eligible with physician approval); are pregnant, planning a pregnancy, or lactating have a history or current diagnosis of psychosis, general anxiety disorder,bipolar disorder, or schizophrenia have a current diagnosis of depression (if past diagnosis, must be symptom free for ≥ the past 12 months) have an allergy to Varenicline ever contemplated or attempted suicide have serious/unstable disease within the past 6 months (e.g., cancer [but melanoma], heart disease, HIV/AIDS) have a history of epilepsy or seizure disorder have a history or diagnosis within the last 6 months of abnormal rhythms and/or tachycardia (>100 beats/minute) have a history or current diagnosis of COPD; cardiovascular disease (stroke, angina); heart attack in the last 6 months; and/or uncontrolled hypertension (SBP>150 or DBP>90)16) have a history of kidney or liver failure have any medical condition or medication that could compromise safety as determined by a study physician cannot provide informed consent or complete the study tasks as determined by the Principal Investigator or study physician.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

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: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Varenicline<br> | Drug: Varenicline<br>* Participants will be randomized to receive varenicline or placebo for 12 weeks. The dosing regimen consistent with FDA guidelines will be used: Day 1-Day 3 (0.5mg once daily); Day 4-Day 7 (0.5mg twice daily); and Day 8-Day 84 (1.0mg twice daily).<br>* Other names: Chantix;Behavioral: Counseling<br>* All participants will be provided with a structured behavioral counseling program, involving 6 counseling sessions by a trained NDDTC counselor. This will be a manual-based intervention and revised as needed for cultural relevance and sensitivity by Dr. Stigler. The intervention is designed to enhance awareness of the harmful effects of smokeless tobacco, assist the person in developing skills to quit and avoid relapse, and instruct the smokeless tobacco user on medication adherence, as recommended by experts in the field.<br>* Other names: Behavioral Counseling;|
| Placebo Comparator: Placebo<br> | Behavioral: Counseling<br>* All participants will be provided with a structured behavioral counseling program, involving 6 counseling sessions by a trained NDDTC counselor. This will be a manual-based intervention and revised as needed for cultural relevance and sensitivity by Dr. Stigler. The intervention is designed to enhance awareness of the harmful effects of smokeless tobacco, assist the person in developing skills to quit and avoid relapse, and instruct the smokeless tobacco user on medication adherence, as recommended by experts in the field.<br>* Other names: Behavioral Counseling;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 7-day Point Prevalence Smokeless Tobacco Abstinence Biochemically Confirmed With Urine Cotinine at the End of 12 Weeks of Treatment. |  | At the end of treatment (12 weeks) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Nicotine Withdrawal and Craving, Negative Affect, Positive Affect, and Side Effects. | Side Effects | Ongoing throughout the treatment period (Baseline to the end of treatment, 12 weeks) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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nicotine smokeless tobacco chewing tobacco varenicline