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Counseling is equal to varenicline to help adolescents quit smoking
Clinical Question
Is varenicline effective in helping adolescents quit smoking?
Bottom line
In this study, varenicline was no more effective than weekly counseling to help adolescents and young adults quit smoking. 1b-
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Government
Setting: Outpatient (any)
Synopsis
This study included adolescents and young adults (14 to 21 years of age) who had smoked for at least 6 months and desired to quit. The researchers randomized the adolescents to receive weekly smoking cessation counseling sessions plus placebo (n = 80) or weekly smoking cessation counseling sessions plus varenicline (n = 77). The study lasted for 12 weeks and the varenicline dose was based on weight. Patients who weighed more than 55 kilograms received 0.5 mg daily for 3 days, then 0.5 mg twice daily for 4 days, and 1 mg twice daily thereafter. Those who weighed 55 kilograms or less received 0.5 mg daily for 7 days and 0.5 mg twice daily thereafter. The researchers confirmed smoking cessation primarily by measuring urinary cotinine levels. The authors don't describe using intention to treat to analyze the data. This typically results in overestimating the effectiveness of interventions. At the end of the study, the rate of smoking cessation was 8.9% in both groups. The rate of adverse events was more than 70% in both groups. Interestingly, way more than half of the participants had positive urine assays for cannabinoids. Finally, a total of only 82 participants completed the study.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
varenicline vs counseling
I won't be using varenicline. Counseling seems equally effective.
Small numbers, small effect…
Small numbers, small effect size, and 'way more' than half of them were probably also smoking marijuana, given the positive urinary cannabinoids. A 'real life' sample, illustrating the challenges of dealing with addictive behaviours.