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Reinforcing or modifying therapy helps avid smokers quit smoking
Last reviewed: 02.07.2025
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For most smokers, the first attempt to quit is likely to be unsuccessful, but a new study from the University of Texas MD Anderson Cancer Center found that patients were more likely to quit if their smoking cessation program was modified and the dose was increased. The researchers also found that varenicline, a smoking cessation drug, was more effective than combination nicotine replacement therapy (CNRT), such as patches or lozenges.
A study published in JAMA found that smokers who failed to quit with varenicline in the first phase of the trial were seven times more likely to quit by the end of the second phase if varenicline doses were increased.
The percentage of those who successfully quit smoking also nearly doubled if they switched from a CNRT regimen to varenicline. These results compare favorably with the almost zero chance of abstinence in patients who were switched from varenicline to CRNT or remained on the same treatment plans.
"These data indicate that sticking with the same medication is ineffective for smokers who fail to quit within the first six weeks of treatment," said lead researcher Paul Cinciripini, PhD, chairman of the department of behavioral sciences.
"Our study should encourage doctors to check on patients early in their quitting journey and, if patients are struggling, try a new approach, such as increasing the dose of medication."
The double-blind, placebo-controlled trial followed 490 smokers who were randomized to receive six weeks of varenicline or CNRT. After the first phase, those who failed to quit were re-randomized to continue, switch, or increase the dose of the drug for an additional six weeks.
Initial treatment included 2 mg varenicline or CNRT (21 mg patch plus 2 mg lozenge). Participants who were rerandomized either continued the same dose of varenicline or CNRT, switched from varenicline to CNRT or vice versa, or received an increased dose of 3 mg varenicline or CNRT (42 mg patch plus 2 mg lozenge). The study was conducted in Texas from June 2015 to October 2019.
Of patients who received varenicline and had their doses increased, 20% remained abstinent after six weeks. Meanwhile, the abstinence rate was 14% among patients who switched from CNRT to varenicline or had their CNRT doses increased. However, patients receiving varenicline who switched to CNRT showed a 0% quit rate. After six months, only those who had their doses increased remained continuously abstinent.
Tobacco use remains the leading preventable cause of death and disease in the United States. Each year, about 480,000 Americans die from tobacco-related diseases. More than 16 million Americans currently suffer from at least one smoking-related disease, including cancer.
Stopping tobacco use can improve survival chances by 30 to 40 percent in cancer patients who smoke. Because the average smoker makes several quit attempts before successfully beating their addiction, MD Anderson addresses barriers to quitting at the individual and population level, including cost, access to cessation services, and knowledge gaps among health care providers in treating tobacco dependence.
In a larger ongoing study, researchers are testing several different drug combinations as alternatives for those who cannot quit smoking on starting doses of varenicline or CNRT.