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Walker N, Verbiest M, Kurdziel T, Laking G, Laugesen M, Parag V, Bullen C. Effectiveness and safety of nicotine patches combined with e-cigarettes (with and without nicotine) for smoking cessation: study protocol for a randomised controlled trial. BMJ Open 2019; 9:e023659. [PMID: 30808668 PMCID: PMC6398670 DOI: 10.1136/bmjopen-2018-023659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/15/2018] [Accepted: 12/20/2018] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Evidence indicates e-cigarettes can help people quit smoking; however, more confirmatory trials are needed. To date, no trials have evaluated the effectiveness and safety of combining nicotine patches with e-cigarettes (with and without nicotine) for smoking cessation. METHODS AND ANALYSIS This study is a pragmatic, three-arm, community-based, single-blind, randomised trial undertaken in New Zealand. Eligible participants are daily/non-daily smokers, aged ≥18 years, naive e-cigarette users and motivated to quit smoking in the next 2 weeks. Participants (n=1809), recruited using multi-media advertising, are randomised to 14 weeks of (1) 21 mg nicotine patches (n=201); (2) 21 mg nicotine patches+18 mg/mL nicotine e-cigarette (n=804); or (3) 21 mg nicotine patches+nicotine free e-cigarette (n=804). Participants receive weekly withdrawal-oriented behavioural support calls for 6 weeks post-randomisation. The primary outcome is self-reported biochemically verified continuous abstinence (CA) at 6 months post quit-date. The primary comparison is nicotine patch + nicotine e-cigarette versus nicotine patch + nicotine free e-cigarette, and the secondary comparison is nicotine patch versus nicotine patch +nicotine e-cigarette (90% power, p=0.05, to detect an absolute difference in 6 month CA rates of 8% and 15% respectively). Secondary outcomes, collected by phone interview at quit date, then 1, 3, 6 and 12 months post-quit date, include self-reported CA, 7 day point prevalence abstinence, cigarettes per day (if smoking, or when smoking for non-daily smokers), time to relapse (if returned to smoking), belief in ability to quit, use of other cessation support, side effects/serious adverse events, treatment compliance, seeking additional support around e-cigarette use, daily use of both e-cigarettes and cigarettes, use of treatment past 14 weeks, views on treatment and recommendation to others, weight and cost-per-quitter. ETHICS AND DISSEMINATION The Northern A Health and Disability Ethics Committee approved the trial. Findings will be disseminated through publication, conference/meeting presentations, and media. TRIAL REGISTRATION NUMBER NCT02521662; Pre-results.
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Affiliation(s)
- Natalie Walker
- School of Population Health, National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Marjolein Verbiest
- School of Population Health, National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
- Tilburg University, Tilburg, The Netherlands
| | - Tomasz Kurdziel
- School of Population Health, National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - George Laking
- Department of Oncology, School of Medical Sciences, The University of Auckland, Auckland, New Zealand
| | - Murray Laugesen
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Varsha Parag
- School of Population Health, National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
| | - Chris Bullen
- School of Population Health, National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
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Walker N, Smith B, Barnes J, Verbiest M, Kurdziel T, Parag V, Pokhrel S, Bullen C. Cytisine versus varenicline for smoking cessation for Māori (the indigenous people of New Zealand) and their extended family: protocol for a randomized non-inferiority trial. Addiction 2019; 114:344-352. [PMID: 30276931 PMCID: PMC6587772 DOI: 10.1111/add.14449] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/27/2018] [Accepted: 09/23/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Cytisine, a nicotinic acetylcholine receptor partial agonist (like varenicline) found in some plants, is a low-cost, effective smoking cessation medication that may appeal to Māori [the indigenous people of New Zealand (NZ)]. The RAUORA trial aims to determine the effectiveness, safety and cost-effectiveness of cytisine (Tabex® ) versus varenicline (Champix® ) for smoking cessation in Māori and the whānau (extended family) of Māori. DESIGN Pragmatic, community-based, open-label randomized non-inferiority trial. SETTING Lakes District Health Board region, NZ. PARTICIPANTS Daily smokers (n = 2140) who self-identify as Māori or whānau of Māori, and are: aged ≥ 18 years, motivated to quit smoking in the next 2 weeks, eligible for subsidized varenicline, able to provide verbal consent and have daily access to a mobile phone/internet. Recruitment uses multi-media advertising. INTERVENTION AND COMPARATOR Participants are randomized (1 : 1 ratio) to receive a prescription for 12 weeks of cytisine tablets [following the manufacturer's dosing regimen for 25 days, then one 1.5-mg tablet every 6 hours (two per day) until 12 weeks] or varenicline tablets (following the manufacturer's dosing regimen). Both groups receive brief stop-smoking advice from the prescribing doctor and withdrawal-orientated behavioural support via community-based stop-smoking counselling services (frequency, duration and mode of delivery tailored for participants) or a research assistant (six weekly 10-15-minute calls). Participants are advised to reduce their smoking over the first 4 days of treatment, with day 5 as their designated quit-date. MEASUREMENTS The primary outcome is carbon monoxide-verified continuous abstinence at 6 months post-quit date. Secondary outcomes at 1, 3, 6 and 12 months post-quit date include: self-reported continuous abstinence, 7-day point prevalence abstinence, cigarettes per day, time to (re)lapse, adverse events, treatment adherence/compliance, treatment acceptability, nicotine withdrawal/urge to smoke and health-care utilization/health-related quality of life. COMMENTS This trial compares cytisine and varenicline when used by the indigenous people of NZ and their extended family for smoking cessation.
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Affiliation(s)
- Natalie Walker
- National Institute for Health Innovation (NIHI), School of Population HealthThe University of AucklandAucklandNew Zealand
| | - Barry Smith
- Lakes District Health BoardRotoruaNew Zealand
| | - Joanne Barnes
- School of PharmacyThe University of AucklandAucklandNew Zealand
| | - Marjolein Verbiest
- National Institute for Health Innovation (NIHI), School of Population HealthThe University of AucklandAucklandNew Zealand,Tranzo Scientific Centre for Care and Welfare, School of Social and Behavioral SciencesTilburg UniversityTilburgthe Netherlands
| | - Tomasz Kurdziel
- National Institute for Health Innovation (NIHI), School of Population HealthThe University of AucklandAucklandNew Zealand
| | - Varsha Parag
- National Institute for Health Innovation (NIHI), School of Population HealthThe University of AucklandAucklandNew Zealand
| | - Subhash Pokhrel
- Health Economics Research GroupBrunel University LondonUxbridgeUK
| | - Chris Bullen
- National Institute for Health Innovation (NIHI), School of Population HealthThe University of AucklandAucklandNew Zealand
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Bullen C, Verbiest M, Galea-Singer S, Kurdziel T, Laking G, Newcombe D, Parag V, Walker N. The effectiveness and safety of combining varenicline with nicotine e-cigarettes for smoking cessation in people with mental illnesses and addictions: study protocol for a randomised-controlled trial. BMC Public Health 2018; 18:596. [PMID: 29728074 PMCID: PMC5935940 DOI: 10.1186/s12889-018-5351-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/21/2018] [Indexed: 11/15/2022] Open
Abstract
Background Smoking rates are higher in New Zealand (NZ) adults with mental illnesses and alcohol and other drug (AOD) addictions, compared to the overall population. Quit attempts using “gold standard” smoking cessation treatments often fail in people with these conditions, so more flexible treatment regimens that adapt to a person’s responsiveness to treatment are worth investigating. The STATUS trial aims to evaluate the effectiveness and safety of combining varenicline with nicotine e-cigarettes for smoking cessation among varenicline non-responders in treatment for mental health illnesses and/or AOD addictions. Methods This is a pragmatic two-arm, open-label, randomised trial. Participants will be daily smokers using mental health and/or addiction services in Auckland, aged ≥18 years, motivated to quit smoking, and eligible to access varenicline through the NZ special authority process. After 2 weeks of using varenicline plus behavioural support, participants who have not reduced their daily smoking by ≥50% will be randomised (1:1) to either 10 weeks of continued varenicline use or 10 weeks of varenicline plus an 18 mg/mL nicotine e-cigarette. All participants will receive weekly withdrawal-orientated behavioural support calls for 6 weeks post-randomisation. The primary outcome is self-reported biochemically-verified (exhaled carbon monoxide) continuous abstinence at 24 weeks post-randomisation. Secondary outcomes, measured at six, 12 and 24 weeks post-randomisation include: self-reported continuous abstinence, 7-day point prevalence abstinence, smoking reduction, time to relapse, cross-over, use of other smoking cessation support, serious adverse events, treatment adherence, compliance, acceptability, dual use, continuation of treatment use, mental illness symptoms and AOD use, health-related quality of life, and cost-analysis. A sample size of 338 will confer 80% power (p = 0.05) to detect a 15% absolute difference between the varenicline alone and varenicline plus e-cigarette groups. Discussion People with mental illness and/or AOD addictions are just as motivated as others to quit smoking, but are less likely to succeed. Adapting smoking cessation medication after a lack of responsiveness in the first 2 weeks of initial treatment in this priority population by adding a nicotine e-cigarette may be one way to increase long-term quit rates. Trial Registration Australian NZ Clinical Trial Registry: ACTRN12616001355460 (29 September 2016). Electronic supplementary material The online version of this article (10.1186/s12889-018-5351-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chris Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand. .,Centre for Addiction Research, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Marjolein Verbiest
- National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.,Centre for Addiction Research, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Susanna Galea-Singer
- Centre for Addiction Research, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.,Community Alcohol & Drug Services, Waitemata District Health Board, Pitman House, 50 Carrington Road, Point Chevalier, Auckland, 1003, New Zealand
| | - Tomasz Kurdziel
- National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - George Laking
- School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - David Newcombe
- Centre for Addiction Research, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.,Department of Social and Community Health, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Varsha Parag
- National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Natalie Walker
- National Institute for Health Innovation, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.,Centre for Addiction Research, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
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