title: Predictors of lapse and relapse to smoking in successful quitters in a varenicline post hoc analysis in Japanese smokers.
abstract: BACKGROUND
  The efficacy of the smoking-cessation agent varenicline has been reported in Asian smokers; however, few studies have investigated factors that contribute to lapse and relapse.
  
  
  OBJECTIVE
  This post hoc analysis aimed to identify predictors of smoking lapse and relapse.
  
  
  METHODS
  This was a post-hoc analysis based on a double-blind, placebo-controlled, randomized, parallel-group study in which Japanese smokers (aged 20-75 years) who smoked ≥ 10 cigarettes/day and were motivated to quit were randomized to receive varenicline (0.25 mg twice daily [BID], 0.5 mg BID, 1 mg BID) or placebo for 12 weeks followed by a 40-week non-treatment follow-up. For inclusion in this analysis, participants must have been nicotine dependent (Tobacco Dependence Screener score ≥ 5) and must have successfully quit smoking continuously for 4 weeks (weeks 9-12). Lapse was defined by answering yes to ≥ 1 question in the Nicotine Use Inventory. Relapse was defined by participants having smoked for ≥ 7 days during follow-up measured by the Nicotine Use Inventory.
  
  
  RESULTS
  Of the 619 randomized individuals, 515 had a Tobacco Dependence Screener score of ≥ 5, and 277 quit smoking continuously from weeks 9 to 12. Approximately 75% were male, with a mean (SD) BMI of 23.0 (3.0) kg/m(2). Maximum length of continuous abstinence (CA) during treatment and age (both P < 0.0001) were significant predictors of lapse. Maximum CA (P < 0.0001), age (P = 0.0002), Minnesota Nicotine Withdrawal Scale (MNWS) score for urge to smoke (P = 0.0019), and having made ≥ 1 serious quit attempt (P = 0.0063) were significant predictors of relapse. For participants with a maximum CA of 4 to 6 weeks versus those with a maximum CA of 10 to 11 weeks, the ORs for lapse and relapse were 4.649 (95% CI, 2.071-10.434) and 3.337 (95% CI, 1.538-7.239), respectively. In participants aged 21-34 years versus those aged 47-72 years, the ORs for lapse and relapse were 3.453 (95% CI 1.851, 6.441) and 3.442 (95% CI 1.795, 6.597), respectively. Participants with a MNWS urge to smoke score of 2 to 4 versus 0 had an OR for relapse of 3.175 (95% CI, 1.166-8.644). Participants having made ≥ 1 versus no serious quit attempts had an OR for relapse of 2.108 (95% CI, 1.168-3.805).
  
  
  CONCLUSIONS
  Shorter maximum CA and younger age at quit attempt were associated with increased risk of lapse and relapse. Higher MNWS urge to smoke score and having made ≥ 1 serious quit attempt were associated with increased relapse risk. ClinicalTrials.gov identifier: NCT00139750.
authors.affiliation: Department of Health Promotion and Prevention, Osaka Center for Cancer and Cardiovascular Diseases Prevention, Osaka, Japan. Electronic address: masa12masa12@m3.dion.ne.jp.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Cancer Information Services, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Oshima
authors.affiliation: Pfizer Japan Inc, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohkura
authors.affiliation: Pfizer Inc, New York, New York.
authors.forename: Carmen
authors.initials: C
authors.lastname: Arteaga
authors.affiliation: Pfizer Japan Inc, Tokyo, Japan.
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Suwa
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018722:Nicotinic Agonists / Q000627:therapeutic use*; D012008:Recurrence; D012907:Smoking; D016540:Smoking Cessation; D014029:Tobacco Use Disorder / Q000517:prevention & control*; D000068580:Varenicline / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D018722:Nicotinic Agonists; D000068580:Varenicline
keywords: Japan; lapse; relapse; smoking cessation; varenicline