Clinical trial NCT01772641: A Smoking Intervention Study Using Scheduled Gradual Reduction With Varenicline to Help With Cessation
Official title: A Combination of Scheduled Reduced Smoking With Varenicline to Enhance Cessation
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: PHASE4
Conditions: Nicotine Addiction
Keywords: cigarette
smoking
cessation
varenicline
scheduled reduction
craving
Lead sponsor: Icahn School of Medicine at Mount Sinai
Sponsor class: OTHER
Collaborators: name: National Institute on Drug Abuse (NIDA)
First posted: 2013-01-21
Enrollment: 32
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: FACTORIAL
Primary purpose: TREATMENT

Brief summary: This study has three main aims. Aim 1: To provide initial data on the efficacy of combined Scheduled Gradual Reduction (SGR) and Varenicline (VN) for smoking cessation, by assessing abstinence and levels of smoking at 2 time points (4 and 12 weeks post quit). Aim 2: To explore the possibility that SGR+VN will be particularly efficacious among smokers with higher background levels of Cue Reactivity (CR), as assessed at the start of the study, using a classic experimental smoking CR paradigm. Aim 3: To explore possible mechanisms underlying the effects of SGR+VN, by assessing potential mediators (i.e., self-efficacy, cue-induced cravings) of treatment effects.

Detailed description: Smoking remains an intransigent public health concern. There is ample evidence that non-pharmacological factors, such as environmental triggers (e.g., sight or smell of a cigarette), can give rise to strong classically-conditioned urges to smoke (termed 'cue-reactivity' \[CR\]), and that exposure to smoking cues can contribute to cessation failure. One promising intervention that may address CR is scheduled smoking with gradual reduction (SGR). Under SGR, individuals smoke only at fixed intervals, and over several weeks, systematically decrease their cigarettes consumed each day. The approach is postulated to: 1) provide 'practice' coping with environmentally-triggered cravings that occur during the inter-cigarette intervals, yielding increased self-efficacy to quit, and 2) weaken the associations between cues and smoking. Accumulating evidence has also shown that the smoking cessation drug, varenicline (VN), substantially ameliorates cravings and enhances cessation, significantly outperforming other drugs. Interestingly, recent animal research suggests that VN may operate at least partially by dampening conditioned drug cravings. A combination therapy consisting of SGR+VN might thus lead to significantly enhanced cessation, simultaneously attacking cravings using both pharmacological and non-pharmacological approaches. Because the beneficial effects of SGR and VN may be at least partially due to enhanced management of conditioned cravings, it is possible that that they will be particularly efficacious for smokers with high levels of CR. Using both laboratory experimental techniques and a prospective intervention design in this R34 application, we propose to provide initial data to: 1) test the hypothesis that a combination of SGR+VN will enhance cessation, 2) explore the possibility that SGR and VN might be particularly efficacious among smokers with higher levels of CR, and 3) explore potential mechanisms underlying treatment effects. Findings from this study would set the stage for larger efficacy and effectiveness trials of SGR alone and in conjunction with VN, as well as efforts to target SGR and/or VN toward the subgroups that would benefit the most (e.g., smokers with high levels of CR, carriers of specific smoking-related genotypes).

Eligibility criteria: Inclusion Criteria:

* Current cigarette smoker
* Averages at least 10 cigarettes/day for 5 or more years
* DSM-IV diagnosis of Nicotine Dependence
* Breath carbon monoxide \> 6 ppm
* Motivated to quit: score \> 8 on Contemplation Ladder
* Age \> 18 years

Exclusion Criteria:

* Current illicit substance use
* Other tobacco use (e.g., cigar, pipe)
* History of psychosis
* Past or current cardiovascular disease
* Impaired renal functioning
* Pregnancy
* Nursing
* Current treatment for smoking cessation
* Clinically significant depressive symptoms (CES-D \> 16)
* Current suicidal ideation

Primary outcomes:
measure: Comparison of Prolonged Abstinence
timeFrame: up to12 weeks post-quit
Secondary outcomes:
measure: Comparison of Continuous Abstinence
timeFrame: 30 days post-quit and 30 days post end-of-treatment
measure: Comparison of Survival
timeFrame: 30 days post-quit and 30 days post end-of-treatment
Other outcomes:
Locations:
city: New York
country: United States
facility: Icahn School of Medicine at Mount Sinai
state: New York
Study officials:
affiliation: Icahn School of Medicine at Mount Sinai
name: Joel Erblich, Ph.D
role: PRINCIPAL_INVESTIGATOR
References: