An intervention that utilised smoking cessation therapy prescribed over the internet was feasible and effective, according to data published in the journal Drug and Alcohol Dependence, writes Erin T Welsh for Healio.
“The era of technology-based clinical research is certainly upon us,” Dr Laurie Zawertailo, senior scientist in the Campbell Family Mental Health Research Institute and Addictions Division at the Centre for Addiction and Mental Health (CAMH) in Toronto, told Healio for an article published on 10 February 2022.
“This large-scale trial illustrates how an internet-enabled smoking cessation programme was able to reach individuals who smoke all across Ontario, whilst maintaining the clinical effectiveness of two first-line smoking-cessation medications: varenicline and bupropion.”
The researchers conducted the open-label, randomised controlled Medication Aids for Tobacco Cessation Health(MATCH) study, which was exclusively internet-based.
The study included 964 current smokers in Ontario, Canada. Participants were randomly assigned via the internet to receive varenicline 1 mg (Pfizer; n = 499; mean age, 47 years; 45.5% men) or bupropion 150 mg (GlaxoSmithKline; n = 465; mean age, 46 years; 42.9% men) for 12 weeks. The medication was sent to participants via mail.
The primary outcome was seven-day point prevalence abstinence, which was defined as no cigarette puffs in the past seven days at 12 weeks. Secondary outcomes included seven-day point prevalence abstinence at four, eight, 26 and 52 weeks during follow-up.
“We knew from previous epidemiological data that the major barriers to receiving evidence-based pharmacotherapy for smoking cessation was accessibility and cost,” Zawertailo told Healio.
“We wanted to address this gap and design a free online programme that would be able to reach and treat Ontarians in need of these services.”
The seven-day point prevalence abstinence was 30.3% among participants in the varenicline group compared with 19.6% in the bupropion group at 12 weeks (OR = 2.08; 95% CI, 1.49-2.9; P < .001).
The varenicline group also had higher seven-day point prevalence abstinence at three weeks (OR = 1.71; 95% CI, 1.23-2.4; P = .0001) and eight weeks of follow-up (OR = 1.95; 95% CI, 1.43-2.67; P < .001) compared with the bupropion group.
However, the varenicline group did not demonstrate higher seven-day point prevalence abstinence at post-treatment follow-up at eight, 26 and 52 weeks.
In addition, researchers observed more adverse events, including vivid dreams (59% vs. 36.3%; P < .001), fatigue (48.1% vs. 35.8%; P = .03) and nausea (52.7% vs. 20.6%; P < .001), among participants in the varenicline group compared with the bupropion group.
“The primary findings were in line with what was expected from these medications. What was surprising, however, was the heterogeneity of the participants that we reached, especially within smaller rural communities.
“This is important because traditional in-person clinical trials usually take place in large urban academic hospitals, precluding the participation of more rural populations,” Zawertailo told Healio.
The results of this study could be used to inform the design of future web-based medication trials for smoking cessation, according to the researchers.
“Unfortunately, even with effective pharmacotherapies, long-term smoking cessation remains a roadblock for many smokers,” Zawertailo said. “We need more research to identify the risk factors for relapse and how to combat it.”
Study details
Drug and Alcohol Dependence journal article – Evaluating the effectiveness of bupropion and varenicline for smoking cessation using an internet-based delivery system: A pragmatic randomized controlled trial (MATCH study) (Restricted access)
Helena Zhanga, Tara Mansoursadeghi-Gilan, Sarwar Hussain, Scott Veldhuizen, Bernard Le Foll, Peter Selby and Laurie Zawertailo
Author affiliations: Centre for Addiction and Mental Health in Toronto, and the University of Toronto, Canada.
Published online by Drug and Alcohol Dependence on 9 February 2022.
Abstract
Traditional randomised controlled trials have demonstrated the efficacy of pharmacotherapy for smoking cessation. However, accessibility to treatments remains a barrier, necessitating the remote delivery of evidence-based cessation interventions.
The aim of this study was to evaluate the effectiveness of an online treatment that included first-line prescription medications using a pragmatic randomized controlled trial design.
Methods
This study was a two-group, parallel block randomised, open label, controlled trial, and conducted exclusively online.
Participants were randomised (1:1) to either bupropion (150 mg) or varenicline (1 mg) for twelve weeks. Medication was couriered to participants. The primary outcome was seven-day point prevalence abstinence (PPA; defined as 0 cigarette puffs in the last 7 days) at 12 weeks.
Secondary outcomes were seven-day PPA at 4-, 8-, 26-, and 52-weeks follow-up. Adverse events were evaluated at each follow-up session during treatment.
Results
The varenicline group (n = 499) had significantly higher 7-day PPA (30.3%) compared to the bupropion group (n = 465; 19.6%) at end of treatment (OR=2.08, 95% CI: 1.49–2.90, p < 0.001). Seven-day PPA was also higher for the varenicline group at four weeks (OR=1.71, 95% CI: 1.23–2.40 p = 0.0001), and eight-weeks follow-up (OR=1.95, 95% CI: 1.43–2.67 p < 0.0001), but not at post-treatment follow-up. More adverse events were reported in the varenicline group, compared to bupropion.
Conclusions
This internet-based pharmacotherapy intervention was a feasible and effective method of treatment delivery for smoking cessation. This method can be used to increase the accessibility and availability of cessation interventions, decreasing the burden of smoking-related diseases.
Healio story – Web-based prescription of smoking-cessation therapy feasible, effective (Open access)
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