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The Role of Nicotine Dose and Route of Delivery in Affecting Adoption of E-cigarettes and Reducing Exposure to Toxic Combustion Products (ENDS-Switch)

Primary Purpose

Nicotine Dependence, Cigarettes

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Nicotine patch
Placebo patch
E-cigarettes
Non-nicotine e-cigarettes
Sponsored by
Duke University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Nicotine Dependence, Cigarettes focused on measuring Nicotine addiction, Cigarette smoking, Nicotine patches, E-cigarettes

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Smoke an average of at least 10 cigarettes per day;
  • Have smoked at least one cumulative year;
  • Have an expired air CO reading of at least 10ppm;
  • Have a body weight of > 110 lbs. (50 kg) and ≤ 300 lbs. (136 kg);
  • Are able to read and understand English;

Potential subjects of child bearing potential must agree to use acceptable contraception during their participation in this study. Potential subjects must agree to avoid the following during their participation in this study:

  • Participation in any other nicotine-related modification strategy outside of this protocol;
  • Use of tobacco products other than cigarettes, including pipe tobacco, cigars, snuff, and chewing tobacco;
  • Use of e-cigarettes other than the ones provided during the study;
  • Use of experimental (investigational) drugs or devices;
  • Use of illegal drugs;
  • Use of exclusionary medications.

Exclusion Criteria:

  • Seeking treatment for nicotine dependence.
  • Hypertension - systolic BP > 160 mm Hg, diastolic BP > 100 mm Hg. Individuals with a history of hypertension may be allowed to participate in the study if the study physician or medical provider determines that the condition is stable and will not jeopardize the individual's safety.
  • Hypotension (with symptoms) - systolic BP < 90 mm Hg, diastolic BP < 60 mm Hg.
  • Coronary heart disease with symptoms (e.g., chest pain)
  • Heart attack in the past year
  • Cardiac rhythm disorder (irregular heart rhythm with symptoms)
  • Chest pain in the last month (unless history indicates a non-cardiac source)
  • Symptomatic heart disorder such as heart failure
  • Advanced liver or kidney disease that requires medication or dialysis, paracentesis
  • Major gastrointestinal illness (e.g. Celiac disease, Crohn's dx Ulcerative Colitis)
  • Bleeding stomach ulcers in the past 30 days
  • Lung disease that requires oxygen
  • Major brain disorder (including stroke with residual deficit, brain tumor, and seizure disorder)
  • Migraine headaches that occur more frequently than once per week
  • Recent, unexplained fainting spells
  • Problems giving blood samples
  • Diabetes with insulin use or with HbA1C over 7%
  • Current cancer or treatment for cancer in the past six months (except basal or squa-mous cell skin cancer)
  • HIV, Hepatitis B, or Hepatitis C
  • History of Tuberculosis or recent positive purified protein derivative (PPD)
  • Other major medical condition (as determined by study physician)
  • Currently symptomatic psychiatric disease (as determined by study physician)
  • Psychosis, bipolar disorder, or psychiatric hospitalization within the past 12 months
  • Suicidal ideation (thinking about ways to commit suicide) (within the past 12 months) or a lifetime occurrence of attempted suicide;
  • Current depression - The Patient Health Questionnaire PHQ-9 for Depression will be used to screen for current (within 2 weeks) depression. Potential subjects who score >9 (or who score >0 on item #9 ("Thoughts that you would be better off dead, or of hurting yourself in some way") will be excluded from study participation, and, at the discretion of the study physician, referred to appropriate psychiatric treatment;
  • Pregnant or nursing mothers
  • Use (within the past 30 days) of:

    • Illegal drugs (or if the urine drug screen is positive for tetrahydrocannabinol (THC), Cocaine, Amphetamine, Opiates, Methamphetamines, phencyclidine (PCP), Benzodiazepines, or Barbiturates), unless recent use of prescription Opiates or Benzodiazepines were taken for management of acute symptoms (e.g., tooth extraction, recent surgery);
    • Experimental (investigational) drugs;
    • Psychiatric medications including antidepressants (selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressant (TCAs), monoamine oxidase inhibitors (MAOIs), St. John's Wort), lithium, anti-psychotics or any other medications that are known to affect smoking cessation (e.g. clonidine);
    • Phentermine, triptans, tryptophan, linezolid, dextromethorphan, opiates (unless taken for management of acute symptoms), tramadol, or dopamine agonists;
    • Any agents that have documented correlation with increased incidence of valvulopathy and/or pulmonary hypertension (e.g., cyproheptadine, trazodone, nefazodone, amoxapine, tricyclic antidepressants, mirtazapine, pergolide, ergotamine, methysergide) (or anticipated use during the study);
    • Wellbutrin, bupropion, Zyban, Chantix, varenicline, nicotine patch, nicotine replacement therapy or any other smoking cessation aid;
    • Use of cigars, cigarillos, pipes, Hookah, dissolvable nicotine, snuff, chewing tobacco, or e-cigarettes
  • Concurrent use of a serotonergic agent/combination associated with severe serotonin syndrome (within the past 30 days)
  • Use of cigars, cigarillos, pipes, Hookah, dissolvable nicotine, snuff, chewing tobacco, or e-cigarettes within the past 30 days
  • Self-report of consuming more than 6 alcoholic drinks on 1 or more days per week
  • Significant adverse reaction to nicotine patch in the past
  • Current participation or recent participation (in the past 30 days) in another smoking study at our Center or another research facility
  • Current participation in another research study

Sites / Locations

  • Duke Center for Smoking Cessation

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Active Comparator

Active Comparator

Active Comparator

Placebo Comparator

Arm Label

Nicotine e-cigs + Nicotine patches

Non-nicotine e-cigs + Nicotine patches

Nicotine e-cigs + Placebo patches

Non-nicotine e-cigs + Placebo patches

Arm Description

Participants will receive e-cigarettes containing nicotine and nicotine patches (21mg/24hr) and will be asked to switch from cigarette use to use of the study e-cigarettes for eight weeks.

Participants will receive e-cigarettes not containing nicotine and nicotine patches (21mg/24hr) and will be asked to switch from cigarette use to use of the study e-cigarettes for eight weeks.

Participants will receive e-cigarettes containing nicotine and placebo patches (21mg/24hr) and will be asked to switch from cigarette use to use of the study e-cigarettes for eight weeks.

Participants will receive e-cigarettes not containing nicotine and placebo patches (21mg/24hr) and will be asked to switch from cigarette use to use of the study e-cigarettes for eight weeks.

Outcomes

Primary Outcome Measures

Expired Air Carbon Monoxide (CO) to Assess Recent Smoking
The effects of e-cigarette nicotine content and patch nicotine content on the concurrent use of conventional cigarettes will be assessed by comparing the groups on the expired air carbon monoxide (CO) measured at the end of the exposure period (Week 8).

Secondary Outcome Measures

Cigarette Use, Assessed by Self-report in Daily Dairies
The effects of e-cigarette nicotine content and patch nicotine content on the concurrent use of conventional cigarettes will be assessed by comparing the groups on self-report of cigarette consumption on daily diaries (for week 8 only, average cigarettes smoked per day).
E-cigarette Use, Assessed by Self-report in Daily Dairies
The effects of e-cigarette nicotine content and patch nicotine content on the concurrent use of e-cigarettes will be assessed by comparing the groups on self-report of e-cigarette use on daily diaries (for week 8 only).
Total Urinary 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL)
The effects of e-cigarette nicotine content and patch nicotine content on the concurrent use of conventional cigarettes will be assessed by comparing the groups on total urinary NNAL, a metabolite of the tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), at the end of week 8.

Full Information

First Posted
April 3, 2018
Last Updated
January 13, 2023
Sponsor
Duke University
Collaborators
National Institute on Drug Abuse (NIDA)
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1. Study Identification

Unique Protocol Identification Number
NCT03492463
Brief Title
The Role of Nicotine Dose and Route of Delivery in Affecting Adoption of E-cigarettes and Reducing Exposure to Toxic Combustion Products
Acronym
ENDS-Switch
Official Title
The Role of Nicotine Dose and Route of Delivery in Affecting Adoption of E-cigarettes and Reducing Exposure to Toxic Combustion Products
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Completed
Study Start Date
August 6, 2018 (Actual)
Primary Completion Date
May 31, 2021 (Actual)
Study Completion Date
May 31, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Duke University
Collaborators
National Institute on Drug Abuse (NIDA)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This study plans to investigate whether using electronic cigarettes (e-cigarettes) or skin patches containing nicotine affects switching from smoking conventional combustible (burning) cigarettes.
Detailed Description
This study proposes to assess the relative role of nicotine dose and route of delivery in affecting successful switching from combustible cigarettes to e-cigarettes, as well as concomitant reductions in ad libitum cigarette smoking and exposure to harmful and potentially harmful constituents of combustion. The strategy will be to assess adoption of e-cigarette use and concomitant reduction in ad libitum smoking of subjects' usual brands of cigarettes over an 8-week period, during which they will receive nicotine or non-nicotine e-cigarettes, and nicotine skin patches. The nicotine patches will not be used as a therapeutic treatment in this study, but rather as a way to manipulate the nicotine dose, while varying the rate and route of nicotine delivery. Behavioral or "habit" aspects of e-cigarette use will be controlled for by the groups receiving non-nicotine e-cigarettes. Initially the study design included placebo patch control conditions, but due to limitations in budget and period of support, enrollment in these these arms was discontinued. All participants currently receive active nicotine patches.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Nicotine Dependence, Cigarettes
Keywords
Nicotine addiction, Cigarette smoking, Nicotine patches, E-cigarettes

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare Provider
Allocation
Randomized
Enrollment
94 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Nicotine e-cigs + Nicotine patches
Arm Type
Active Comparator
Arm Description
Participants will receive e-cigarettes containing nicotine and nicotine patches (21mg/24hr) and will be asked to switch from cigarette use to use of the study e-cigarettes for eight weeks.
Arm Title
Non-nicotine e-cigs + Nicotine patches
Arm Type
Active Comparator
Arm Description
Participants will receive e-cigarettes not containing nicotine and nicotine patches (21mg/24hr) and will be asked to switch from cigarette use to use of the study e-cigarettes for eight weeks.
Arm Title
Nicotine e-cigs + Placebo patches
Arm Type
Active Comparator
Arm Description
Participants will receive e-cigarettes containing nicotine and placebo patches (21mg/24hr) and will be asked to switch from cigarette use to use of the study e-cigarettes for eight weeks.
Arm Title
Non-nicotine e-cigs + Placebo patches
Arm Type
Placebo Comparator
Arm Description
Participants will receive e-cigarettes not containing nicotine and placebo patches (21mg/24hr) and will be asked to switch from cigarette use to use of the study e-cigarettes for eight weeks.
Intervention Type
Drug
Intervention Name(s)
Nicotine patch
Other Intervention Name(s)
NicoDerm
Intervention Description
Participants will wear the nicotine patch daily while switching from cigarette use to use of e-cigarettes for eight weeks.
Intervention Type
Other
Intervention Name(s)
Placebo patch
Intervention Description
Participants will wear the placebo patch daily while switching from cigarette use to use of e-cigarettes for eight weeks.
Intervention Type
Other
Intervention Name(s)
E-cigarettes
Other Intervention Name(s)
Electronic Nicotine Delivery System (ENDS), e-cigs, electronic cigarettes
Intervention Description
Participants will use e-cigarettes containing nicotine while switching from cigarette use to use of e-cigarettes for eight weeks.
Intervention Type
Other
Intervention Name(s)
Non-nicotine e-cigarettes
Other Intervention Name(s)
Electronic Nicotine Delivery System (ENDS), e-cigs, electronic cigarettes
Intervention Description
Participants will use e-cigarettes not containing nicotine while switching from cigarette use to use of e-cigarettes for eight weeks.
Primary Outcome Measure Information:
Title
Expired Air Carbon Monoxide (CO) to Assess Recent Smoking
Description
The effects of e-cigarette nicotine content and patch nicotine content on the concurrent use of conventional cigarettes will be assessed by comparing the groups on the expired air carbon monoxide (CO) measured at the end of the exposure period (Week 8).
Time Frame
Week 8
Secondary Outcome Measure Information:
Title
Cigarette Use, Assessed by Self-report in Daily Dairies
Description
The effects of e-cigarette nicotine content and patch nicotine content on the concurrent use of conventional cigarettes will be assessed by comparing the groups on self-report of cigarette consumption on daily diaries (for week 8 only, average cigarettes smoked per day).
Time Frame
Week 8
Title
E-cigarette Use, Assessed by Self-report in Daily Dairies
Description
The effects of e-cigarette nicotine content and patch nicotine content on the concurrent use of e-cigarettes will be assessed by comparing the groups on self-report of e-cigarette use on daily diaries (for week 8 only).
Time Frame
Week 8
Title
Total Urinary 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL)
Description
The effects of e-cigarette nicotine content and patch nicotine content on the concurrent use of conventional cigarettes will be assessed by comparing the groups on total urinary NNAL, a metabolite of the tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), at the end of week 8.
Time Frame
Week 8

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Smoke an average of at least 10 cigarettes per day; Have smoked at least one cumulative year; Have an expired air CO reading of at least 10ppm; Have a body weight of > 110 lbs. (50 kg) and ≤ 300 lbs. (136 kg); Are able to read and understand English; Potential subjects of child bearing potential must agree to use acceptable contraception during their participation in this study. Potential subjects must agree to avoid the following during their participation in this study: Participation in any other nicotine-related modification strategy outside of this protocol; Use of tobacco products other than cigarettes, including pipe tobacco, cigars, snuff, and chewing tobacco; Use of e-cigarettes other than the ones provided during the study; Use of experimental (investigational) drugs or devices; Use of illegal drugs; Use of exclusionary medications. Exclusion Criteria: Seeking treatment for nicotine dependence. Hypertension - systolic BP > 160 mm Hg, diastolic BP > 100 mm Hg. Individuals with a history of hypertension may be allowed to participate in the study if the study physician or medical provider determines that the condition is stable and will not jeopardize the individual's safety. Hypotension (with symptoms) - systolic BP < 90 mm Hg, diastolic BP < 60 mm Hg. Coronary heart disease with symptoms (e.g., chest pain) Heart attack in the past year Cardiac rhythm disorder (irregular heart rhythm with symptoms) Chest pain in the last month (unless history indicates a non-cardiac source) Symptomatic heart disorder such as heart failure Advanced liver or kidney disease that requires medication or dialysis, paracentesis Major gastrointestinal illness (e.g. Celiac disease, Crohn's dx Ulcerative Colitis) Bleeding stomach ulcers in the past 30 days Lung disease that requires oxygen Major brain disorder (including stroke with residual deficit, brain tumor, and seizure disorder) Migraine headaches that occur more frequently than once per week Recent, unexplained fainting spells Problems giving blood samples Diabetes with insulin use or with HbA1C over 7% Current cancer or treatment for cancer in the past six months (except basal or squa-mous cell skin cancer) HIV, Hepatitis B, or Hepatitis C History of Tuberculosis or recent positive purified protein derivative (PPD) Other major medical condition (as determined by study physician) Currently symptomatic psychiatric disease (as determined by study physician) Psychosis, bipolar disorder, or psychiatric hospitalization within the past 12 months Suicidal ideation (thinking about ways to commit suicide) (within the past 12 months) or a lifetime occurrence of attempted suicide; Current depression - The Patient Health Questionnaire PHQ-9 for Depression will be used to screen for current (within 2 weeks) depression. Potential subjects who score >9 (or who score >0 on item #9 ("Thoughts that you would be better off dead, or of hurting yourself in some way") will be excluded from study participation, and, at the discretion of the study physician, referred to appropriate psychiatric treatment; Pregnant or nursing mothers Use (within the past 30 days) of: Illegal drugs (or if the urine drug screen is positive for tetrahydrocannabinol (THC), Cocaine, Amphetamine, Opiates, Methamphetamines, phencyclidine (PCP), Benzodiazepines, or Barbiturates), unless recent use of prescription Opiates or Benzodiazepines were taken for management of acute symptoms (e.g., tooth extraction, recent surgery); Experimental (investigational) drugs; Psychiatric medications including antidepressants (selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressant (TCAs), monoamine oxidase inhibitors (MAOIs), St. John's Wort), lithium, anti-psychotics or any other medications that are known to affect smoking cessation (e.g. clonidine); Phentermine, triptans, tryptophan, linezolid, dextromethorphan, opiates (unless taken for management of acute symptoms), tramadol, or dopamine agonists; Any agents that have documented correlation with increased incidence of valvulopathy and/or pulmonary hypertension (e.g., cyproheptadine, trazodone, nefazodone, amoxapine, tricyclic antidepressants, mirtazapine, pergolide, ergotamine, methysergide) (or anticipated use during the study); Wellbutrin, bupropion, Zyban, Chantix, varenicline, nicotine patch, nicotine replacement therapy or any other smoking cessation aid; Use of cigars, cigarillos, pipes, Hookah, dissolvable nicotine, snuff, chewing tobacco, or e-cigarettes Concurrent use of a serotonergic agent/combination associated with severe serotonin syndrome (within the past 30 days) Use of cigars, cigarillos, pipes, Hookah, dissolvable nicotine, snuff, chewing tobacco, or e-cigarettes within the past 30 days Self-report of consuming more than 6 alcoholic drinks on 1 or more days per week Significant adverse reaction to nicotine patch in the past Current participation or recent participation (in the past 30 days) in another smoking study at our Center or another research facility Current participation in another research study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jed E. Rose, Ph.D.
Organizational Affiliation
Duke University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Duke Center for Smoking Cessation
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27705
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

The Role of Nicotine Dose and Route of Delivery in Affecting Adoption of E-cigarettes and Reducing Exposure to Toxic Combustion Products

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