Effectiveness of varenicline for smoking cessation at 2 urban academic health centers.
BACKGROUND
Smoking is a major cause of morbidity in lower socioeconomic groups. In randomized trials, varenicline improves long term quit rates, but effectiveness in a clinic setting is unknown.


METHODS
We conducted a retrospective cohort study of adults who received a prescription for varenicline or nicotine replacement therapy (NRT) at two inner city health centers in 2008-9. Primary outcome was smoking status at 52 weeks. Secondary outcomes included follow up visits, behavioral counseling, and side effects. Multivariable Poisson regression was used to compare quit rates with varenicline and NRT adjusted for covariates.


RESULTS
A total of 371 patients received a prescription for varenicline (46%) or NRT (54%). The mean age was 43 years, 58% were female, 44% white, 29% African American and 12% Hispanic. Mental illness, alcohol and drug abuse were common. Within one year, 247 (67%) had follow-up, and 26 (10.5%) maintained abstinence through week 52, 10.2% with varenicline and 10.8% with NRT (p=1.0). Loss to follow-up was 37% for varenicline, 31% for NRT (p=0.20). Including lost patients as smokers, the adjusted quit rates for varenicline and NRT were similar (6.5% vs. 7.6%, p=0.69). Only 69/371 (19%) received behavioral counseling. Counseled patients were more likely to maintain abstinence (13% vs. 7.8%, p=0.04). Side effects were more common with varenicline than NRT (6.5% vs. 2.5%, p=0.07).


CONCLUSIONS
In an inner city clinic, abstinence rates were lower than those in clinical trials and did not differ between varenicline and NRT.
Division of General Medicine, Baystate Medical Center, Springfield, MA 01199, USA. ranjitdhelaria@yahoo.co.uk
Ranjit K
RK
Dhelaria
Jennifer
J
Friderici
Kelly
K
Wu
Ella
E
Gupta
Cyrus
C
Khan
Michael B
MB
Rothberg
D000046:Academic Medical Centers; D000328:Adult; D001552:Benzazepines / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D016012:Poisson Distribution; D011810:Quinoxalines / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D016540:Smoking Cessation / Q000379:methods*; D061485:Tobacco Use Cessation Devices / Q000009:adverse effects; D016896:Treatment Outcome; D000068580:Varenicline
D001552:Benzazepines; D011810:Quinoxalines; D000068580:Varenicline