Adaptive Pharmacotherapy Shows Promise in Smoking Cessation: JAMA

A recent study published in the Journal of American Medical Association found that adaptive pharmacotherapy, a method of tailoring medication regimens based on patient response, significantly improves smoking cessation rates in a clinical practice setting. The study, stopped early due to the COVID-19 pandemic, compared adaptive treatment with standard treatment for smoking cessation. 

Unlike traditional approaches that provide a fixed medication regimen, adaptive treatment allows for adjustments based on the patient's response to the treatment. While previous studies have shown the efficacy of adaptive treatment using precessation nicotine patches, the use of precessation varenicline (a medication to help quit smoking) and its application in clinical practice settings remained largely unexplored.

The primary objective of this double-blinded, stratified placebo-controlled randomized clinical trial was to determine whether adaptive pharmacotherapy could achieve higher smoking abstinence rates compared to standard pharmacotherapy in a real-world clinical practice setting. 

Participants in the trial were given the choice between varenicline or nicotine patches, and they were then randomized into either the adaptive or nonadaptive (standard) treatment group. The adaptive group began their chosen medication four weeks before their target quit day. After two weeks, participants were assessed for their response to the treatment.

Nonresponders in the adaptive group, those who didn't reduce their daily cigarette consumption by at least 50%, received additional medication (bupropion) alongside their chosen treatment. Responders in the adaptive group and participants in the standard group received placebo treatment. 

The main outcome measure was biochemically verified 30-day continuous smoking abstinence 12 weeks after their target quit smoking day. The trial enrolled 188 participants, with an average age of 49.1 years, of which 54% were female.

The results were promising, showing that adaptive pharmacotherapy was significantly more effective than standard treatment. Biochemically verified 30-day continuous smoking abstinence was observed in 24% of participants in the adaptive treatment group compared to only 9% in the standard treatment group.

Among participants who used varenicline, the adaptive treatment group showed a 28% abstinence rate compared to 8% in the standard treatment group.

However, it's worth noting that sleep problems were more common in the varenicline adaptive treatment group than in the varenicline standard treatment group.

Reference:

Davis, J. M., Masclans, L., & Rose, J. E. (2023). Adaptive Smoking Cessation Using Precessation Varenicline or Nicotine Patch. In JAMA Network Open (Vol. 6, Issue 9, p. e2332214). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2023.32214