Varenicline’s Release Did Little to Alter National Smoking Cessation Rates

Varenicline (Chantix) joined the list of FDA-approved smoking cessation agents in 2006 amid a backdrop of promising clinical data and a fair amount of marketing.

Yet, according to a recent study comparing the most recent national tobacco use data available with data obtained before varenicline’s release, the introduction of the medication has had little impact on the total number of smokers using cessation pharmacotherapies or on the overall cessation rate.

These findings are par for the course, however, noted Shu-Hong Zhu, Ph.D., who led the population-based study, published August 17 in the journal Tobacco Control.

“We have been looking at data from over the past two decades and so far none of the recent developments in smoking intervention, such as the advent of nicotine replacement therapies or tobacco price increases, has increased the quit rate,” Zhu, a professor of family medicine and public health at the University of California, San Diego, told Psychiatric News.

Varenicline had some elements that hinted it might break this trend and make an impact, Zhu added. The clinical studies that led to its approval suggested it was superior to existing cessation agents. Additionally, the requirement of a prescription would get doctors engaged in the process, and studies have shown that physician involvement can increase the rates of trying to quit.

But when comparing tobacco use survey data from 2003 with data collected from 2010 to 2011, Zhu’s group found the introduction of varenicline was associated with only a 2.4 percent increase in the use of cessation pharmacotherapies (from 28.7 to 31.1 percent), while the overall cessation rate was virtually unchanged (4.5 percent to 4.7 percent).

“This is not in any way saying that varenicline has been a failure,” Zhu said. “On an individual level, it has worked great for many people. At the population level, though, varenicline has only served to replace other pharmacotherapies and change the market share of cessation drugs.”

Specifically, bupropion—another prescribed agent—has been the most affected, with its use among smokers dropping from 9.1 percent in 2003 to 3.5 percent from 2010 to 2011, while 10.9 percent took varenicline from 2010 to 2011.

The analysis explored the effects of age, gender, and ethnicity but found no real trends in these subgroups other than an increase in pharmacotherapy usage among seniors between 2003 and 2011.

Zhu acknowledged that varenicline may have made a positive impact in some other subsets of the population, such as people with psychiatric illnesses among whom smoking is a serious issue; however, his group’s analysis did not have detailed population statistics to explore this.

“There have been reports that varenicline has serious neuropsychiatric effects, but it also has far fewer adverse interactions with other drugs than bupropion, so psychiatrists now have more of a choice when considering a cessation strategy for a patient,” he said.

“However, at a broad level, this work reinforces that it doesn’t necessarily matter how many options to help quitting you have or how well the drug did in clinical studies. We cannot make a national impact unless you have more people who want to quit. And this applies to not only smoking aids, but medications for alcohol and other drugs.”

Zhu’s study was supported by a grant from the National Cancer Institute under the State and Community Tobacco Control Initiative. ■