University of Oklahoma
No published studies to date have evaluated the combined impact of varenicline and oral nicotine replacement therapy (NRT) on smoking cessation in a randomized trial. Oral NRT, such as nicotine lozenges, can provide acute relief from cravings/withdrawal, and offers individuals the flexibility to deliver nicotine quickly, in contrast with the continuous, passive, and slow-acting delivery of the nicotine patch. Nevertheless, in clinical trials of other combination pharmacotherapies, participants' adherence to of oral NRT has been suboptimal, making it difficult to determine whether there is an added benefit. Given the near-ubiquity of smartphone ownership (85% of U.S. adults), it is plausible that smartphone-based medication adherence interventions could have a positive influence on pharmacotherapy adherence and smoking cessation. This investigative team has demonstrated the feasibility and potential efficacy of using combination varenicline plus oral NRT treatment to promote smoking cessation in a pilot factorial randomized trial. Likewise, pilot findings showed that medication adherence and smoking cessation rates were higher among those who received smartphone-based medication reminders than those who did not. The proposed study will enroll 496 adults who smoke cigarettes daily. The study will employ a 2x2 factorial design in which participants will be randomized to one of four combinations of two treatment factors: 1) pharmacological treatment (varenicline + nicotine lozenges vs. varenicline alone) and 2) smartphone medication adherence intervention (smartphone-based smoking cessation app with vs. without adherence components). The primary study outcomes will be biochemically-confirmed 7-day point prevalence abstinence at 26 weeks after a scheduled quit date, and medication adherence over the 13-week treatment period. Smartphone-based daily diaries will be employed to assess daily smoking and medication adherence. Notably, the proposed study will employ entirely remote assessment and treatment delivery strategies. Exploratory analyses will evaluate the potential interaction between medication type and the smartphone adherence intervention, and compare the influences of pharmacological treatment type and the medication adherence intervention on weekly physical symptoms (e.g., withdrawal, medication side effects). The overarching goal of the proposed research is to improve smoking cessation treatment and decrease cancer risk.
Study Overview. The study will employ an efficient 2x2 factorial design in which participants are randomized to one of four combinations of two treatment factors: 1) pharmacological treatment (VAR+NRT or VAR) and 2) smartphone-based smoking cessation intervention with or without medication adherence intervention (COMBO-A \[adherence\] or COMBO-B \[basic\]). All participants will receive 13 weeks of varenicline including the standard 1-week pre-quit titration period, with half of participants additionally receiving 12 weeks of nicotine lozenges. Those assigned to the COMBO-A group will receive…
Inclusion Criteria: * Able to provide documentation of identity (to prevent fraudulent enrollment) and Oklahoma residence (due to limitations on prescribing to out-of-state residents) * Reports daily smoking ≥5 cigarettes per day * Provides a breath CO sample ≥6ppm to verify current smoking * Willing to schedule a smoking cessation attempt within the next 1-2 weeks * Willing to abstain from smoking cannabis or other combustible products during the study * Willing to use varenicline and nicotine lozenges * Willing to participate in the study for ≈6 months * Able to demonstrate \>6th grade lite…
13 weeks of varenicline
12 weeks of nicotine lozenges
Smartphone-based smoking cessation intervention with adherence components
Smartphone-based smoking cessation intervention without adherence components
Up to 6 telephone counseling sessions with a tobacco treatment specialist