Quantitative assessment of exposure-response relationships for the efficacy and tolerability of varenicline for smoking cessation.
Population exposure-response analyses involving approximately 2,000 cigarette smokers provided an integrated understanding of dose, exposure, patient characteristics, and response relating to the efficacy and tolerability of varenicline for smoking cessation. Full models with a linear function of area under the concentration-time curve at steady state AUC(0-24)(ss) and covariate effects on the baseline probability of response were constructed. Logistic regression results consistently showed that the end-of-treatment abstinence rate increased with increasing varenicline exposure, from 38% at 0.5 mg b.i.d. to 56% at 1 mg b.i.d. (vs. 22% for placebo). Baseline smoking status and age were predictive of smoking cessation, whereas race and gender showed little or no influence. Nausea was the most common adverse event, with an incidence that was gender-related and that increased with varenicline exposure; at a dosage of 1 mg b.i.d. the predicted probability of nausea relative to placebo was 24 vs. 7% in male subjects and 40 vs. 14% in female subjects. The incidence of nausea also showed a decreasing trend with time.
Ravva
P
P
Global Pharmacometrics, Primary Care Business Unit, Worldwide Pharmaceutical Operations, Pfizer Inc., New London, Connecticut, USA. patanjali.ravva@pfizer.com
Gastonguay
M R
MR
French
J L
JL
Tensfeldt
T G
TG
Faessel
H M
HM
D000293:Adolescent; D000328:Adult; D000368:Aged; D001552:Benzazepines / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011810:Quinoxalines / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics; D018570:Risk Assessment; D012907:Smoking / Q000188:drug therapy* / Q000378:metabolism / Q000639:trends; D016540:Smoking Cessation / Q000379:methods*; D016896:Treatment Outcome; D000068580:Varenicline; D055815:Young Adult
D001552:Benzazepines; D011810:Quinoxalines; D000068580:Varenicline