Friday, July 27, 2012

Pharmaceutical Nicotine and Chantix: 93% Failure Rate Reconfirmed

A study published in the European Journal of Internal Medicine indicates that pharmaceutical nicotine and Chantix (varenicline) had 93% failure rates at two inner city academic health center clinics with predominantly Medicaid patients (abstract here). 

First author Dr. Ranjit Dhelaria from Baystate Medical Center in Springfield, MA, was joined by coauthors from Tufts University in Boston and Allegheny General Hospital in Pittsburgh .

Dhelaria and colleagues reviewed the medical records of 371 patients who received prescriptions for nicotine or Chantix.  The subjects averaged 43 years of age, and had been smoking some 16 cigarettes per day for 22 years.  Forty-four percent had a history of mental illness; drug abuse and alcohol abuse were also prevalent (24% and 12% respectively).

The overall quit rate was 7.0%, with no difference between nicotine and Chantix.  This information was self-reported by the subjects and not verified, so the actual rate may have been even lower.  A 93% failure rate for pharmaceutical nicotine was first published in a review nine years ago (here).  Dhelaria and colleagues note that these real-world quit rates are much lower than those reported in clinical trials, which are typically designed to enroll highly motivated participants. 

The authors make two dubious statements. First, they imply that patient counseling can dramatically affect smoking cessation: “Providing a brief period of counseling (three minutes or less) has been shown in clinical trials to augment rates of abstinence by approximately 30%...”  In fact, such “augmentation,” if fully effective, would have only increased their 7.0% success rate to 9.1% -- a resounding failure still.

Under “Learning Points,” the authors write: “Varenicline and nicotine replacements were equally effective for smoking cessation.”  Use of the term “effective” for substances that fail in 93 out of 100 cases is inane.

Public health policy should not promote six-dollar-a-day pharmaceuticals with dismal performance records, while demonizing OTC smokeless tobacco products with scientifically established records of success… all in the pursuit of largely unachievable tobacco abstinence.   


Izof_texas said...

Thanks for your contributions to this (forever)ongoing battle.

With safe, tasty, pleasant-to-use powdered dissolvable tobacco tablets available that supply some of the synergistic anatabine that both of these methods fail to offer, all at a cost much lower, and with availabitily at the corner store, without "a doctor's permission", it is inSane for "authorities" to continue to push the lowest success, highest cost options onto those who need it most and can afford it least!

Chris Price said...

If success rates at the 20-month mark for final determination of smoking status are usually about half the 12-month rate, as they seem to be, then the final (and real) success rate measured for NRT and Chantix in this trial is about 3.5%.

However in all open trials I've read where the self-reported status was checked by CO monitor testing, a significant percentage were shown to be self-deceiving and were still smoking. This would seem to indicate that even less than 3.5% would have finally measured as successful at 20 months (as the author infers).

This is probably the lowest success rate ever shown for Chantix - surely it must be wrong. Perhaps it is the patients' fault, as they are noted as having various issues...