search
Back to results

Varenicline in Combination With Nicotine Replacement Therapy for Smoking Cessation

Primary Purpose

Tobacco Dependence

Status
Completed
Phase
Phase 2
Locations
South Africa
Study Type
Interventional
Intervention
Varenicline, Nicotine Patch
Varenicline and Placebo Patch
Sponsored by
University of Stellenbosch
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Tobacco Dependence focused on measuring Smoking, Smoking cessation, Pharmaceutical aids

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Current cigarette smokers, male and female, aged between 18-75 years (both limits inclusive), and who are motivated to stop smoking.
  2. Have smoked on average at least 10 cigarettes per day during past year and during the month prior to screening, and no period of abstinence greater than 3 months in the past year.
  3. Women of child-bearing potential (WCBP) may be included provided they are not pregnant, not nursing, and meet all of the following criteria:

    • instructed and agree to avoid pregnancy through 30 days after the last dose of study medication
    • negative screening test (beta-HCG) at screening
    • agree to use at least one birth control method (oral contraceptive, IUD, implantable or injectable contraceptive for at least 1 month prior to entering the study and will continue its use through at least 30 days after the last dose of study medication, or use a barrier method of contraception (p.e.condom, diaphragm with spermicide) while participating in the study through at least 30 days after the last dose of study medication; or abstinence.
  4. Patients must have no serious or unstable disease in the past 6 months.
  5. Patients must be able to be outpatients, to be assessed in a clinical setting, and be able and willing to comply with all study visits during the treatment and non-treatment periods.
  6. Only one subject per household may participate.

Exclusion Criteria:

  1. Patients currently suffering from depression or who have been diagnosed with depression or treated with anti-depressants within the past 12 months.
  2. Patients with a past of present history of psychosis, panic disorder, or bipolar disorder.
  3. Patients with severe chronic obstructive pulmonary disease (COPD).
  4. Patients with clinically significant cardiovascular disease in the past 6 months. such as myocardial infarction, coronary artery bypass graft (CABG), percutaneous transluminal coronary angioplasty (PTCA), severe or unstable angina, serious arrhythmia, and clinically significant ECG conduction abnormalities.
  5. Patients with uncontrolled hypertension or a systolic blood pressure greater than 150mmHg or as diastolic pressure greater than 95mmHg at screening or baseline.
  6. Patients with clinically significant neurological disorders or cerebrovascular diseases (for example, stroke, transient ischemic attack, etc.) in the past 6 months.
  7. Patients with a history of clinically significant endocrine disorders or gastrointestinal diseases, including insulin dependent diabetes mellitus, uncontrolled hyperthyroidism, and active peptic ulcer.
  8. Patients with clinically significant hepatic or renal impairment or other clinically significant abnormal laboratory test values.
  9. Patients with a history of cancer (cured basal cell or squamous cell carcinoma of the skin allowed).
  10. Patients with a history of clinically significant allergic reactions to drugs (for example, severe cutaneous and/or systemic allergic reactions).
  11. Patients with a history of drug (except nicotine) or alcohol abuse or dependence within the past 12 months.
  12. Patients with a body mass index (BMI) less than 15 or greater than 38 when wearing indoor clothing without shoes. No subject will be enrolled with a weight less than 45.5kg (100 pounds).
  13. Patients previously enrolled in a study that included varenicline.
  14. Patients having used nicotine replacement therapy within the last 6 months.
  15. Patients taking another investigational drug within 30 days or 5 half-lives (whichever is longer) before the Baseline visit or within 30 days of study completion.
  16. Use of prohibited medications: any antidepressants, including bupropion; antipsychotic agents; mood stabilizers; naltrexone; steroids (inhaled and topical steroids are permitted); insulin.
  17. Patients who do not agree to completely abstain from using non-cigarette tobacco products (including for example, pipe tobacco, cigars, snuff, chewing tobacco, etc.) or marijuana during study participation.
  18. Patients who intend to donate blood or blood components while receiving study drug or within 1 month of the completion of the study treatment.
  19. Patients unable/or unlikely to comprehend and follow the study protocol, including patients unable and/or unwilling to participate in the non-treatment follow-up. Patients who, in the investigator's opinion, will be unlikely to commit to a 6 month-long study.
  20. Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or investigational product administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the subject inappropriate for entry into this study.

Sites / Locations

  • Respiratory Research Unit
  • Synopsis Research
  • UCT Lung Institute
  • Dr JA O'Brien
  • Dr AHH Brüning
  • Dr MS Abdool-Gaffar
  • Dr C Smith

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Active Comparator

Arm Label

Varenicline and Placebo Patch

Varenicline and Nicotine Patch

Arm Description

Varenicline and Nicotine Patch (placebo)

Varenicline and Nicotine Patch 15mg

Outcomes

Primary Outcome Measures

continuous abstinence (CAR) from weeks 9 to 12 of treatment
The primary endpoint is the 4-week continuous abstincence rate for week 9 - 12 of treatment, i.e. the proportion of patients who are able to maintain complete abstinence from cigarette smoking and other nicotine use, with end-expiratory exhaled carbon monoxide (CO) measurements 10 ppm or less, for the planned last 4 weeks of treatment.

Secondary Outcome Measures

CAR from weeks 9 to 24
The secondary endpoint is the 4-week continuous abstincence rate for week 9 - 24 of treatment, i.e. the proportion of patients who are able to maintain complete abstinence from cigarette smoking and other nicotine use, with end-expiratory exhaled carbon monoxide (CO) measurements 10 ppm or less, for the planned last 4 weeks of treatment.

Full Information

First Posted
September 27, 2011
Last Updated
March 25, 2014
Sponsor
University of Stellenbosch
Collaborators
QuitSupport
search

1. Study Identification

Unique Protocol Identification Number
NCT01444131
Brief Title
Varenicline in Combination With Nicotine Replacement Therapy for Smoking Cessation
Official Title
A 26-Week Phase II, Multicentre, Randomised, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Varenicline in Combination With Nicotine Replacement Therapy for Smoking Cessation
Study Type
Interventional

2. Study Status

Record Verification Date
March 2014
Overall Recruitment Status
Completed
Study Start Date
April 2011 (undefined)
Primary Completion Date
April 2013 (Actual)
Study Completion Date
June 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Stellenbosch
Collaborators
QuitSupport

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to test whether the addition of a nicotine patch to varenicline increases smoking cessation success rate and whether the combination is safe.
Detailed Description
This is a phase-II multicenter study involving 438 smokers, to be conducted at 7 sites in South Africa, over 6 months. In a randomized 1:1 allocation varenicline tartrate 1 mg twice daily, given in an incremental dosage for the first week before target quit date (TQD), will be compared to varenicline tartrate in the same dose combined with a 15mg nicotine patch. The nicotine patch (active and placebo) will be provided by McNeil. The patch will be given 2 weeks prior TQD. Treatment duration from TQD is 12 weeks with varenicline being tapered off during week 13. A total of 12 clinic visits and 1 telephonic contact is planned for the 6-month study duration. The main efficacy outcome will be the 4-week continuous abstinence rate during the last four weeks of treatment, i.e. weeks 9 - 12. Efficacy assessments will be based on a Nicotine Use Inventory and measurements of end-expiratory exhaled carbon monoxide. Safety assessments will be based on adverse events evaluation, with special attention being given to the occurrence of nausea during the pretreatment period, as well as neuro-psychiatric symptoms such as depression or suicidal ideation. Participants will not be subjected to any invasive procedures. This protocol is based on current evidence and two further abstracts presented at the European Respiratory Society Conference in Vienna, September 2009, that a combination of varenicline tartrate and nicotine replacement therapy indicate superior efficacy in cessation rate, but also an excellent good safety profile. This study relates to the area of pharmacotherapy of smoking cessation, and will answer a frequently asked question. Importantly, several leading pulmonologists with experience in smoking cessation in South Africa have expressed their keen interest to participate in this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Tobacco Dependence
Keywords
Smoking, Smoking cessation, Pharmaceutical aids

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
446 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Varenicline and Placebo Patch
Arm Type
Placebo Comparator
Arm Description
Varenicline and Nicotine Patch (placebo)
Arm Title
Varenicline and Nicotine Patch
Arm Type
Active Comparator
Arm Description
Varenicline and Nicotine Patch 15mg
Intervention Type
Drug
Intervention Name(s)
Varenicline, Nicotine Patch
Other Intervention Name(s)
Champix, Nicorette
Intervention Description
active nicotine patches added to varenicline.
Intervention Type
Drug
Intervention Name(s)
Varenicline and Placebo Patch
Intervention Description
placebo nicotine patches added to varenicline.
Primary Outcome Measure Information:
Title
continuous abstinence (CAR) from weeks 9 to 12 of treatment
Description
The primary endpoint is the 4-week continuous abstincence rate for week 9 - 12 of treatment, i.e. the proportion of patients who are able to maintain complete abstinence from cigarette smoking and other nicotine use, with end-expiratory exhaled carbon monoxide (CO) measurements 10 ppm or less, for the planned last 4 weeks of treatment.
Time Frame
3 months
Secondary Outcome Measure Information:
Title
CAR from weeks 9 to 24
Description
The secondary endpoint is the 4-week continuous abstincence rate for week 9 - 24 of treatment, i.e. the proportion of patients who are able to maintain complete abstinence from cigarette smoking and other nicotine use, with end-expiratory exhaled carbon monoxide (CO) measurements 10 ppm or less, for the planned last 4 weeks of treatment.
Time Frame
6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Current cigarette smokers, male and female, aged between 18-75 years (both limits inclusive), and who are motivated to stop smoking. Have smoked on average at least 10 cigarettes per day during past year and during the month prior to screening, and no period of abstinence greater than 3 months in the past year. Women of child-bearing potential (WCBP) may be included provided they are not pregnant, not nursing, and meet all of the following criteria: instructed and agree to avoid pregnancy through 30 days after the last dose of study medication negative screening test (beta-HCG) at screening agree to use at least one birth control method (oral contraceptive, IUD, implantable or injectable contraceptive for at least 1 month prior to entering the study and will continue its use through at least 30 days after the last dose of study medication, or use a barrier method of contraception (p.e.condom, diaphragm with spermicide) while participating in the study through at least 30 days after the last dose of study medication; or abstinence. Patients must have no serious or unstable disease in the past 6 months. Patients must be able to be outpatients, to be assessed in a clinical setting, and be able and willing to comply with all study visits during the treatment and non-treatment periods. Only one subject per household may participate. Exclusion Criteria: Patients currently suffering from depression or who have been diagnosed with depression or treated with anti-depressants within the past 12 months. Patients with a past of present history of psychosis, panic disorder, or bipolar disorder. Patients with severe chronic obstructive pulmonary disease (COPD). Patients with clinically significant cardiovascular disease in the past 6 months. such as myocardial infarction, coronary artery bypass graft (CABG), percutaneous transluminal coronary angioplasty (PTCA), severe or unstable angina, serious arrhythmia, and clinically significant ECG conduction abnormalities. Patients with uncontrolled hypertension or a systolic blood pressure greater than 150mmHg or as diastolic pressure greater than 95mmHg at screening or baseline. Patients with clinically significant neurological disorders or cerebrovascular diseases (for example, stroke, transient ischemic attack, etc.) in the past 6 months. Patients with a history of clinically significant endocrine disorders or gastrointestinal diseases, including insulin dependent diabetes mellitus, uncontrolled hyperthyroidism, and active peptic ulcer. Patients with clinically significant hepatic or renal impairment or other clinically significant abnormal laboratory test values. Patients with a history of cancer (cured basal cell or squamous cell carcinoma of the skin allowed). Patients with a history of clinically significant allergic reactions to drugs (for example, severe cutaneous and/or systemic allergic reactions). Patients with a history of drug (except nicotine) or alcohol abuse or dependence within the past 12 months. Patients with a body mass index (BMI) less than 15 or greater than 38 when wearing indoor clothing without shoes. No subject will be enrolled with a weight less than 45.5kg (100 pounds). Patients previously enrolled in a study that included varenicline. Patients having used nicotine replacement therapy within the last 6 months. Patients taking another investigational drug within 30 days or 5 half-lives (whichever is longer) before the Baseline visit or within 30 days of study completion. Use of prohibited medications: any antidepressants, including bupropion; antipsychotic agents; mood stabilizers; naltrexone; steroids (inhaled and topical steroids are permitted); insulin. Patients who do not agree to completely abstain from using non-cigarette tobacco products (including for example, pipe tobacco, cigars, snuff, chewing tobacco, etc.) or marijuana during study participation. Patients who intend to donate blood or blood components while receiving study drug or within 1 month of the completion of the study treatment. Patients unable/or unlikely to comprehend and follow the study protocol, including patients unable and/or unwilling to participate in the non-treatment follow-up. Patients who, in the investigator's opinion, will be unlikely to commit to a 6 month-long study. Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or investigational product administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the subject inappropriate for entry into this study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Elvis M Irusen, MBChB, FCP, PhD
Organizational Affiliation
University of Stellenbosch
Official's Role
Principal Investigator
Facility Information:
Facility Name
Respiratory Research Unit
City
Cape Town
State/Province
Western Cape
ZIP/Postal Code
7505
Country
South Africa
Facility Name
Synopsis Research
City
Cape Town
State/Province
Western Cape
ZIP/Postal Code
7700
Country
South Africa
Facility Name
UCT Lung Institute
City
Cape Town
State/Province
Western Cape
ZIP/Postal Code
8000
Country
South Africa
Facility Name
Dr JA O'Brien
City
Cape Town
State/Province
Western Cape
ZIP/Postal Code
8001
Country
South Africa
Facility Name
Dr AHH Brüning
City
Gatesville / Cape Town
State/Province
Western Cape
ZIP/Postal Code
7764
Country
South Africa
Facility Name
Dr MS Abdool-Gaffar
City
Amanzimtoti
ZIP/Postal Code
4126
Country
South Africa
Facility Name
Dr C Smith
City
Sandton
ZIP/Postal Code
2010
Country
South Africa

12. IPD Sharing Statement

Citations:
PubMed Identifier
16820546
Citation
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.
Results Reference
background
PubMed Identifier
16820547
Citation
Jorenby DE, Hays JT, Rigotti NA, Azoulay S, Watsky EJ, Williams KE, Billing CB, Gong J, Reeves KR; Varenicline Phase 3 Study Group. Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. JAMA. 2006 Jul 5;296(1):56-63. doi: 10.1001/jama.296.1.56. Erratum In: JAMA. 2006 Sep 20;296(11):1355.
Results Reference
background
PubMed Identifier
16820548
Citation
Tonstad S, Tonnesen P, Hajek P, Williams KE, Billing CB, Reeves KR; Varenicline Phase 3 Study Group. Effect of maintenance therapy with varenicline on smoking cessation: a randomized controlled trial. JAMA. 2006 Jul 5;296(1):64-71. doi: 10.1001/jama.296.1.64.
Results Reference
background
PubMed Identifier
10065662
Citation
Tonnesen P, Paoletti P, Gustavsson G, Russell MA, Saracci R, Gulsvik A, Rijcken B, Sawe U. Higher dosage nicotine patches increase one-year smoking cessation rates: results from the European CEASE trial. Collaborative European Anti-Smoking Evaluation. European Respiratory Society. Eur Respir J. 1999 Feb;13(2):238-46. doi: 10.1034/j.1399-3003.1999.13b04.x.
Results Reference
background
PubMed Identifier
15078238
Citation
Schuurmans MM, Diacon AH, van Biljon X, Bolliger CT. Effect of pre-treatment with nicotine patch on withdrawal symptoms and abstinence rates in smokers subsequently quitting with the nicotine patch: a randomized controlled trial. Addiction. 2004 May;99(5):634-40. doi: 10.1111/j.1360-0443.2004.00711.x.
Results Reference
background
PubMed Identifier
18339101
Citation
Shiffman S, Ferguson SG. Nicotine patch therapy prior to quitting smoking: a meta-analysis. Addiction. 2008 Apr;103(4):557-63. doi: 10.1111/j.1360-0443.2008.02138.x.
Results Reference
background
PubMed Identifier
10926587
Citation
Bolliger CT, Zellweger JP, Danielsson T, van Biljon X, Robidou A, Westin A, Perruchoud AP, Sawe U. Smoking reduction with oral nicotine inhalers: double blind, randomised clinical trial of efficacy and safety. BMJ. 2000 Aug 5;321(7257):329-33. doi: 10.1136/bmj.321.7257.329.
Results Reference
background
PubMed Identifier
19351781
Citation
Ebbert JO, Burke MV, Hays JT, Hurt RD. Combination treatment with varenicline and nicotine replacement therapy. Nicotine Tob Res. 2009 May;11(5):572-6. doi: 10.1093/ntr/ntp042. Epub 2009 Apr 7.
Results Reference
background
PubMed Identifier
17108670
Citation
Bolliger CT, van Biljon X, Axelsson A. A nicotine mouth spray for smoking cessation: a pilot study of preference, safety and efficacy. Respiration. 2007;74(2):196-201. doi: 10.1159/000097136. Epub 2006 Nov 14.
Results Reference
background
PubMed Identifier
25005652
Citation
Koegelenberg CF, Noor F, Bateman ED, van Zyl-Smit RN, Bruning A, O'Brien JA, Smith C, Abdool-Gaffar MS, Emanuel S, Esterhuizen TM, Irusen EM. Efficacy of varenicline combined with nicotine replacement therapy vs varenicline alone for smoking cessation: a randomized clinical trial. JAMA. 2014 Jul;312(2):155-61. doi: 10.1001/jama.2014.7195.
Results Reference
derived

Learn more about this trial

Varenicline in Combination With Nicotine Replacement Therapy for Smoking Cessation

We'll reach out to this number within 24 hrs