Quitting smoking is probably the hardest thing I ask my patients to do. Many patients try to quit multiple times before finally being able to quit permanently. Smoking is a frustrating and profound addiction.
A new medication has recently been approved for smoking cessation. The medication is varenicline and is being marketed under the brand name Chantix. Its efficacy was studied in three randomized blinded trials that were all published in the July 5 issue of the Journal of the AMA (Vol 296, No 1) and reviewed by The Medical Letter.
The studies illustrate the potential, and the limitations, of Chantix. Two of the studies randomized smokers who wanted to quit to receiving either Chantix or bupropion or placebo. Bupropion (marketed as Wellbutrin and Zyban) has already been proven to have some efficacy for smoking cessation. After 12 weeks, continuous smoking cessation rates in both studies were about 18% with placebo, 30% with bupropion (Zyban), and 44% with varenicline (Chantix). So the patients on Chantix did best, but even on Chantix, over half of patients were smoking again at 12 weeks. Nine months after the end of treatment, the results were even more discouraging. Continuous smoking cessation rates were about 9% with placebo, 15.5% with bupropion (Zyban), and 22.5% with varenicline (Chantix). Again, Chantix did best of the three groups, but three quarters of the patients in that group had not successfully quit. Still, that suggests that for every 8 patients given Chantix instead of placebo, one additional patient was able to quit successfully nine months later.
The medication is generally started a week before the patient’s target smoking quit date and continued for 12 weeks. Patients who are successful in quitting smoking during the first 12 weeks should continue the medication for another 12 weeks.
So Chantix is not a magic cure, but it’s significantly better than Zyban. If you know someone who has become discouraged by unsuccessful previous attempts to quit smoking, this might be a good reason to encourage him to try again.