Efficacy of Varenicline for Smokeless Tobacco Use in India

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

Study Overview

• Status: Completed
• Conditions: Tobacco Use Disorder
• Intervention / Treatment: Drug: Varenicline; Behavioral: Counseling

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 237
• Phase: Phase 2

Contacts and Locations

Study Locations

• India
  • New Dehli, India
    • All India Institute of Medical Research

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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:

  1. smoking cessation medications (bupropion, Varenicline, NRT);
  2. antipsychotics, atypicals, mood-stabilizers, anti-depressants (tricyclics, SSRIs, MAOIs), anti-panic agents, anti-obsessive agents, anti-anxiety agents, stimulants;
  3. Anti-coagulants;
  4. 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.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Placebo	Behavioral: Counseling; 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.; Other Names: Behavioral Counseling
Active Comparator: Varenicline	Drug: Varenicline; 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).; Other Names: Chantix; Behavioral: Counseling; 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.; Other Names: Behavioral Counseling

What is the study measuring?

Primary Outcome Measures

Outcome Measure	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)

Collaborators and Investigators

• Sponsor: University of Pennsylvania
• Collaborators: All India Institute of Medical Sciences, New Delhi

Publications and helpful links

General Publications

• Jhanjee S, Jain R, Jain V, Gupta T, Mittal S, Goelz P, Schnoll RA. Evaluating the Effects of Varenicline on Craving, Withdrawal, and Affect in a Randomized, Double-Blind, Placebo-Controlled Clinical Trial of Varenicline for Smokeless Tobacco Dependence in India. J Psychoactive Drugs. 2015 Sep-Oct;47(4):325-30. doi: 10.1080/02791072.2015.1075092. Epub 2015 Aug 28.

Study record dates

Study Major Dates

• Study Start: April 1, 2011
• Primary Completion (Actual): October 1, 2012
• Study Completion (Actual): October 1, 2013

Study Registration Dates

• First Submitted: March 23, 2010
• First Submitted That Met QC Criteria: April 1, 2010
• First Posted (Estimate): April 2, 2010

Study Record Updates

• Last Update Posted (Estimate): July 30, 2015
• Last Update Submitted That Met QC Criteria: July 9, 2015
• Last Verified: June 1, 2015

More Information

Terms related to this study

• Keywords: nicotine smokeless tobacco chewing tobacco varenicline
• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Substance-Related Disorders; Tobacco Use Disorder; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Cholinergic Agents; Nicotinic Agonists; Cholinergic Agonists; Varenicline
• Other Study ID Numbers: 811047