- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01623505
Reducing Cardiovascular Disease by Combining Smoking Cessation Pharmacotherapy and Behavioural Counseling (RW)
Interventions for Cardiovascular Disease: "Real-World" Effectiveness of Combined Pharmacotherapy and Behavioural Counseling for Smoking Cessation
Research Aims
The aims of this research study are:
To determine which of the following three smoking cessation medications is most effective in achieving cessation:
- Nicotine Patch
- Nicotine Patch + gum or inhaler
- Varenicline (Champix;
To investigate how often participants experience neuropsychiatric symptoms over the course of their cessation attempt and to assess whether:
- They occur more often when taking one medication versus another
- They occur more often in those with or without psychiatric illnesses.
Hypotheses to be Tested
The hypotheses to be tested include the following:
- The CO-confirmed continuous abstinence rate from 5 weeks to 52 weeks following a target quit date will be significantly higher in smokers receiving long-term transdermal NRT in combination with other NRT products or those receiving varenicline compared to those receiving transdermal NRT alone.
- Some participants will experience neuropsychiatric symptoms during their cessation attempt, and those in the varenicline group will experience a greater incidence of neuropsychiatric symptoms than those in the groups receiving transdermal NRT alone or in combination with other NRT products. Patients with psychiatric illnesses will report higher levels of withdrawal symptoms than those without psychiatric illnesses.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Participants will be recruited from the UOHI Smoking Cessation Clinic and via media advertisements. Following the baseline assessment, participants will be randomly assigned to one of three groups:
- 10-week standard regimen of transdermal NRT (NRT);
- Long duration of transdermal NRT in combination with other NRT products (NRT+); or
- Varenicline (VR).
Participants assigned to the "NRT" standard regimen group will follow a 10-week treatment of nicotine patches alone.
Participants assigned to the "NRT+" long-duration group will follow the same regimen as the NRT group, but will not be limited to a fixed declining dose strategy, nor limited to a 10-week duration (potential maximum dosage of 35mg/day and maximum treatment duration of up to 22 weeks). Participants will also be provided with other NRT products (i.e., gum or inhaler).
Participants assigned to the "VR" group will start the medication on the day of the baseline assessment and set a target quit date any time within the 8 to 14 day period after baseline. Participants will receive a 12-week supply of varenicline with a possible extension of up to 24 weeks.
All participants will receive six 15-minute counselling sessions from a nurse-counsellor specializing in smoking cessation in accordance with nursing best-practice guidelines. These sessions occur at 1, 3, 5, 8, and 10 weeks post target quit date. Counselling sessions will focus on practical counselling (problem solving and skills training) and social support.
During the treatment phase, participants will complete questionnaires measuring withdrawal and neuropsychiatric symptoms at 1, 3, 5, 8, and 10 weeks. These questionnaires will also be completed at 22 and 52 weeks after the target quit date.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
Ontario
-
Ottawa, Ontario, Canada, K1Y 4W7
- University of Ottawa Heart Insitute - Prevention and Wellness Centre
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Participant is a current smoker (≥ 10 cigarettes per day in the preceding\ six months);
- Participant is willing to make a quit attempt in the 2-4 weeks after initial screening for eligibility;
- Participant is 18 years of age and older;
- Participant is willing to provide informed consent.
Exclusion Criteria:
- Participant is currently using or has used any intervention medications in the previous 6 months (i.e, Champix (varenicline); and/or Nicotine replacement therapy (patch, gum, inhaler, lozenge));
Participant has contraindication(s) to any of the following smoking cessation medications:
- Nicotine replacement therapy (allergic reaction to adhesive; serious cardiac arrhythmias (e.g., tachycardia); participant is during the immediate post-myocardial infarction period (i.e. incident has occurred within the last 10 days); severe or worsening angina pectoris; participant has had a recent cerebral vascular accident);
- Varenicline (end-stage renal disease; use of cimetidine (by participants with severe renal impairment); previous allergic reaction to varenicline);
- Pregnant or breastfeeding women or those intending to become pregnant in the next year;
- Current or previous (in the last 3 months) substance abuse;
- Unable to provide informed consent due to unstable psychiatric symptoms (e.g., active, untreated psychosis or suicidality);
- Participant is unable to read and understand English or French;
- In order to prevent contamination across groups, only one person per household may participate.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Champix
|
Participants receiving this treatment will start the medication on the day of the baseline assessment and set a target quit date within the 8 to 14 day period after baseline. Participants in this group will receive a 12-week supply of varenicline. Treatment will begin 2 weeks before the target quit date and continue for 10 weeks after the target quit date. Participants will be prescribed 0.5 mg once daily for 3 days, 0.5 mg twice daily for 4 days, and 1 mg twice daily for 11 weeks. Participants will be given the option of extending their treatment to a maximum of up to 24 weeks of varenicline. All participants will receive six 15-minute counselling sessions from a nurse-counsellor specializing in smoking cessation.
Other Names:
|
Experimental: Long & Combination patch treatment
|
Participants receiving this treatment will set a quit date within 2 weeks after baseline assessment and apply the patch on that day. This group will follow the same regimen as the "standard patch treatment", but is not limited to a fixed dosing strategy. Participants will be advised on the titration of patch (increase or decrease in dosage) to ensure elimination of withdrawal symptoms (maximum dosage of 35mg/day, maximum treatment of up to 22 weeks). Participants will be provided with either gum or inhaler to manage cravings. All participants will receive six 15-minute counselling sessions from a nurse-counsellor specializing in smoking cessation. *Off-label dosage approved by Health Canada via "No Objection" letter.
Other Names:
|
Experimental: Standard patch treatment
|
Participants receiving this treatment group (standard treatment)will set a target quit date within the 2 weeks after baseline assessment and start to apply the patch on that day. This treatment will consist of a 10-week supply of nicotine patches. The initial dosage will be determined from the average number of cigarettes smoked each day as per the manufacturer's recommendation. Participants smoking ≥ 20 cigarettes per day will be prescribed 21 mg/24 hours for 6 weeks, 14 mg/24 hours for 2 weeks, and 7 mg/24 hours for 2 weeks. Participants smoking 11 - 20 cigarettes per day will be prescribed 14 mg/24 hours for 6 weeks, and 7 mg/24 hours for 4 weeks. All participants will receive six 15-minute counselling sessions from a nurse-counsellor specializing in smoking cessation.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
The primary outcome will be measured at 5, 10, 22, and 52 weeks after the target quit date and include: CO confirmed continuous abstinence from 5-10 weeks, 5-22 weeks and 5-52 weeks.
Time Frame: 5-10 weeks, 5-22 weeks, and 5-52 weeks post target quit date
|
5-10 weeks, 5-22 weeks, and 5-52 weeks post target quit date
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
The secondary outcome will include withdrawal and neuropsychiatric symptoms (e.g., depression, anxiety, suicidal ideation, anger/aggression). These variables will be measured at 1, 3, 5, 8, 10, 22, and 52 weeks following the target quit date.
Time Frame: 1, 3, 5, 8, 10, 22, and 52 weeks post target quit date
|
1, 3, 5, 8, 10, 22, and 52 weeks post target quit date
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Heather E Tulloch, PhD, Ottawa Heart Institute Research Corporation
- Study Chair: Andrew Pipe, MD, Ottawa Heart Institute Research Corporation
- Study Chair: Robert Reid, MBA PhD, Ottawa Heart Institute Research Corporation
- Study Chair: Charl Els, MD, University of Alberta
Publications and helpful links
General Publications
- Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness: A population-based prevalence study. JAMA. 2000 Nov 22-29;284(20):2606-10. doi: 10.1001/jama.284.20.2606.
- Slovinec D'Angelo ME, Reid RD, Hotz S, Irvine J, Segal RJ, Blanchard CM, Pipe A. Is stress management training a useful addition to physician advice and nicotine replacement therapy during smoking cessation in women? Results of a randomized trial. Am J Health Promot. 2005 Nov-Dec;20(2):127-34. doi: 10.4278/0890-1171-20.2.127.
- Gonzales D, Rennard SI, Nides M, Oncken C, Azoulay S, Billing CB, Watsky EJ, Gong J, Williams KE, Reeves KR; Varenicline Phase 3 Study Group. Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. JAMA. 2006 Jul 5;296(1):47-55. doi: 10.1001/jama.296.1.47.
- Aubin HJ, Bobak A, Britton JR, Oncken C, Billing CB Jr, Gong J, Williams KE, Reeves KR. Varenicline versus transdermal nicotine patch for smoking cessation: results from a randomised open-label trial. Thorax. 2008 Aug;63(8):717-24. doi: 10.1136/thx.2007.090647. Epub 2008 Feb 8.
- Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction. 2004 Jan;99(1):29-38. doi: 10.1111/j.1360-0443.2004.00540.x.
- Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff. A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report. Am J Prev Med. 2008 Aug;35(2):158-76. doi: 10.1016/j.amepre.2008.04.009.
- Stapleton JA, Watson L, Spirling LI, Smith R, Milbrandt A, Ratcliffe M, Sutherland G. Varenicline in the routine treatment of tobacco dependence: a pre-post comparison with nicotine replacement therapy and an evaluation in those with mental illness. Addiction. 2008 Jan;103(1):146-54. doi: 10.1111/j.1360-0443.2007.02083.x. Epub 2007 Nov 19.
- Warner KE, Burns DM. Hardening and the hard-core smoker: concepts, evidence, and implications. Nicotine Tob Res. 2003 Feb;5(1):37-48. doi: 10.1080/1462220021000060428.
- Grant BF, Hasin DS, Chou SP, Stinson FS, Dawson DA. Nicotine dependence and psychiatric disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. Arch Gen Psychiatry. 2004 Nov;61(11):1107-15. doi: 10.1001/archpsyc.61.11.1107.
- Tulloch HE, Pipe AL, Els C, Clyde MJ, Reid RD. Flexible, dual-form nicotine replacement therapy or varenicline in comparison with nicotine patch for smoking cessation: a randomized controlled trial. BMC Med. 2016 Jun 7;14:80. doi: 10.1186/s12916-016-0626-2.
- Tulloch HE, Pipe AL, Clyde MJ, Reid RD, Els C. The Quit Experience and Concerns of Smokers With Psychiatric Illness. Am J Prev Med. 2016 Jun;50(6):709-718. doi: 10.1016/j.amepre.2015.11.006. Epub 2015 Dec 17.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- HIPRC-6614
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Smoking Cessation
-
University of Southern CaliforniaAmerican Cancer Society, Inc.CompletedSmoking | Smoking Cessation | Smoking, Cigarette | Smoking Behaviors | Cessation, SmokingUnited States
-
Nabi BiopharmaceuticalsNational Institute on Drug Abuse (NIDA)CompletedSmoking | Smoking Cessation | Tobacco CessationUnited States
-
Heidelberg UniversityPfizerTerminatedSmoking | Smoking Cessation | Tobacco Use CessationGermany
-
Claremont Graduate UniversityNational Cancer Institute (NCI)CompletedSmoking | Smoking Cessation | Tobacco Use | Tobacco Smoking | Tobacco Use Cessation | Smoking, CigaretteUnited States
-
Mayo ClinicNational Institute on Drug Abuse (NIDA)CompletedSmoking | Smoking Cessation | Tobacco Use | Tobacco Smoking | Tobacco Use Cessation | Smoking, Tobacco | Smoking, CigaretteUnited States
-
University of MiamiFlorida Department of HealthRecruitingSmoking Cessation | Tobacco Smoking | Tobacco Use CessationUnited States
-
The University of Hong KongNot yet recruitingSmoking Cessation Counseling Ability | Smoking Cessation Counseling PracticeHong Kong
-
University of ChicagoNational Institute on Drug Abuse (NIDA); National Institutes of Health (NIH)Completed
-
Weill Medical College of Cornell UniversityNational Heart, Lung, and Blood Institute (NHLBI)TerminatedSmoking | Smoking CessationUnited States
-
M.D. Anderson Cancer CenterNational Cancer Institute (NCI)Completed
Clinical Trials on Champix
-
Sahlgrenska University Hospital, SwedenKarolinska University Hospital; Malmö UniversityCompletedAlcohol DependenceSweden
-
Centre for Addiction and Mental HealthPfizer; Ontario Lung AssociationCompleted
-
PfizerCompletedSmoking CessationFrance, Italy
-
ANRS, Emerging Infectious DiseasesPfizerCompletedHIV Infections | Tobacco DependenceFrance
-
Queen Mary University of LondonCompletedSmoking Cessation | Tobacco DependenceUnited Kingdom
-
University of ZagrebHarvard Medical School (HMS and HSDM); University of Ljubljana School of Medicine... and other collaboratorsCompletedSmoking CessationCroatia, Slovenia
-
Shaare Zedek Medical CenterCompletedSmoking CessationIsrael
-
Centre for Addiction and Mental HealthPfizerCompleted
-
PfizerCompletedSmoking CessationKorea, Republic of, China, Philippines, India
-
Queen Mary University of LondonCompletedSmoking Cessation | Tobacco DependenceUnited Kingdom