Frequently Reported Adverse Events With Smoking Cessation Medications: Post Hoc Analysis of a Randomized Trial

OBJECTIVE

To compare the incidence, severity, and clinical course of frequently reported adverse events (AEs) after treatment with smoking cessation pharmacotherapies.

METHODS

This was a multinational, multicenter, post hoc analysis of frequently reported treatment-emergent AEs from a large, phase 4, double-blind, randomized, triple-dummy, placebo-controlled trial (EAGLES), conducted between November 30, 2011, and January 13, 2015, that included smokers with and without psychiatric disorders (N=8144). Treatments were varenicline 1 mg twice daily, bupropion sustained-release 150 mg twice daily, and nicotine patch 21 mg once daily with tapering (12-week treatment, 12-week nontreatment follow-up), with incidence, time to onset, and duration of frequently reported AEs (≥5% of participants in any treatment group) measured. Risk differences for AEs for varenicline and bupropion vs nicotine patch were compared.

RESULTS

Across frequently reported AEs, nausea, insomnia, abnormal dreams, anxiety, irritability, dry mouth, fatigue, and application site pruritus differed significantly in active treatment vs placebo groups. Risk differences were as follows: for nausea with varenicline vs nicotine patch, 15.50% (95% CI, 13.20% to 17.80%); for insomnia with bupropion vs nicotine patch, 2.58% (CI, 0.65% to 4.51%); and for abnormal dreams with varenicline and bupropion vs nicotine patch, -2.49% (CI, -4.35% to -0.64%) and -5.60% (CI, -7.27% to -3.93%), respectively. Frequently reported AEs of severe intensity and treatment discontinuation were experienced by less than 1.5% and less than 3% of participants across all groups, respectively.

CONCLUSION

Active treatments were well tolerated with comparable AE profiles. Most AEs are not clinically important, and prescribers can reassure patients that those experienced will be manageable.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT01456936.

Changes in smoking cessation assistance in the European Union between 2012 and 2017: pharmacotherapy versus counselling versus e-cigarettes

BACKGROUND

The landscape of smoking cessation may have changed in Europe recently.

OBJECTIVES

To identify changes in use of smoking cessation assistance in the European Union (EU) and factors associated with use of cessation assistance.

METHODS

Data from the 2012 (n=9921) and 2017 (n=9489) waves of the Eurobarometer survey were used. Self-reported use of smoking cessation assistance was assessed among smokers who had ever tried to quit and former smokers. Changes in use of each type of assistance were assessed using logistic regression.

RESULTS

Among current and former smokers, those who had ever attempted to quit without assistance increased from 70.3% (2012) to 74.8% (2017). Current smokers were more likely to have used any assistance compared with former smokers (P<0.001). Use of e-cigarettes for smoking cessation assistance increased (3.7% to 9.7%)%), while use of pharmacotherapy (14.6% to 11.1%)%) and smoking cessation services (7.5% to 5.0%)%) declined. Younger people were more likely to have reported e-cigarette use for smoking cessation but less likely to have used a cessation service. Individuals living in countries with comprehensive smoking cessation policies were more likely to have used any cessation assistance (adjusted OR (aOR)=1.78; 95% CI 1.15 to 2.76), pharmacotherapy (aOR=3.44; 95% CI 1.78 to 6.66) and smoking cessation services (aOR=2.27; 95% CI 1.27 to 4.06) compared with those living in countries with weak smoking cessation policies.

CONCLUSIONS

These findings highlight the need for approaches that ensure that smokers get support to quit smoking across the EU. The question of whether the availability of e-cigarettes will displace other methods, and the impact of such a displacement, should be closely evaluated.

Tobacco control achievements and priority areas in the WHO Europe Region: A review

INTRODUCTION

Tobacco control efforts have been advancing globally, including the adoption and entry into force of the World Health Organization (WHO) Framework Convention of Tobacco Control (FCTC), as well as the adoption of the European Union EU Tobacco Products Directive. With the present review, the European Network for Smoking and Tobacco Prevention (ENSP) and European Respiratory Society (ERS) aim to provide a comprehensive overview on the status of WHO FCTC implementation, policy achievements and priority areas across countries in the WHO Europe Region.

METHODS

The review was conducted through a triangulation of data extracted from a survey administered to ENSP members, the WHO FCTC Implementation Database, Tobacco Control Laws and the Tobacco Control Scale 2016.

RESULTS

Using the WHO MPOWER measures as a framework, we report on the implementation status of nine FCTC articles across 47 countries in the WHO Europe Region. The average number of articles fully implemented was 3.58. FCTC articles least fully implemented were: Article 5.3 on Tobacco Industry Interference (25.5%, n=12), Article 20 on Research (34.0%, n=16), and Article 15 on Illicit trade (40.4%, n=19). The most commonly fully implemented articles were: Article 8 on Smoke-free legislation (63.8%, n=30), Article 16 on Underage sales (57.4%, n=27), and Article 6 on Price and tax measures (51.2%, n=24). Policy achievements and recommended priority areas for future national tobacco control activities varied greatly among countries.

CONCLUSIONS

Findings highlight the multitude of successes in tobacco control efforts across the region in recent years, but point out the need to address gaps in FCTC implementation.

Smoking cessation in patients with respiratory diseases: a high priority, integral component of therapy

Smoking cessation is the one of the most important ways to improve the prognosis of patients with respiratory disease. The Task Force on guidelines for smoking cessation in patients with respiratory diseases was convened to provide evidence-based recommendations on smoking cessation interventions in respiratory patients. Based on the currently available evidence and the consensus of an expert panel, the following key recommendations were made. 1) Patients with respiratory disease have a greater and more urgent need to stop smoking than the average smoker, so respiratory physicians must take a proactive and continuing role with all smokers in motivating them to stop and in providing treatment to aid smoking cessation. 2) Smoking cessation treatment should be integrated into the management of the patient's respiratory condition. 3) Therapies should include pharmacological treatment (i.e. nicotine replacement therapy, bupropion or varenicline) combined with behavioural support. 4) Respiratory physicians should receive training to ensure that they have the knowledge, attitudes and skills necessary to deliver these interventions or to refer to an appropriate specialist. 5) Although the cost of implementing these recommendations will partly be offset by a reduction in attendance for exacerbations, etc., a budget should be established to enable implementation. Research is needed to establish optimum treatment strategies specifically for respiratory patients.