Walker, N;
Gainforth, H;
Kiparoglou, V;
Robinson, H;
Van Woerden, H;
West, R;
(2018)
Factors moderating the relative effectiveness of varenicline and nicotine replacement therapy in clients using smoking cessation services.
Addiction
, 113
(2)
pp. 313-324.
10.1111/add.14004.
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Abstract
AIMS: To assess how far the greater effectiveness of varenicline over nicotine replacement therapy (NRT) is moderated by characteristics of the smokers or setting in clinical practice. DESIGN: We used observational data from 22,472 treatment episodes between 2013 and 2016 from smoking cessation services in England to assess whether differences between varenicline and NRT were moderated by a set of smoker and setting characteristics: these included level of social deprivation, age, gender, ethnic group, nicotine dependence, and treatment context. From the above, 15,640 episodes were analysed in relation to 4-week quit and 14,273 episodes at 12 weeks. All two-way interactions involving pharmacotherapy were fitted in addition to the main effects and a parsimonious model identified using a backwards stepwise selection procedure. SETTING: England PARTICIPANTS: Clients of smoking cessation service (number of individuals in 4-week quit analysis = 15,640). MEASUREMENTS: 4-week Carbon monoxide - validated (primary outcome) and 12-week self-reported (secondary outcome) quit success/failure. FINDINGS: At both follow-up points, varenicline was associated with higher success rates overall (p<0.001 at both 4 and 12 weeks; adjusted odds ratio varenicline vs NRT = 1.82 [95%CI 1.61, 2.06] and 2.58 [95%CI 2.26, 2.94] at 4 and 12 weeks respectively). At 12 weeks, the relative benefits of varenicline were found to be influenced by the setting in which advice was provided (p<0.001 for interaction pharmacotherapy × setting; adjusted OR for varenicline × pharmacy setting = 0.53, [95% CI 0.42, 0.69] and for varenicline × General Practice setting = 0.79, [95% CI 0.64, 0.98] against a baseline of 1 for varenicline × community setting). The same trends were evident at 4 weeks but this did not translate to statistical significance. There was inconclusive evidence for moderating effects of other variables. CONCLUSIONS: Varenicline use is associated with higher smoking cessation rates than nicotine replacement therapy in routine clinical practice, irrespective of a wide range of smoker characteristics, but the difference is less in certain intervention settings, most notably pharmacy but also GP practice, compared with community setting.
Type: | Article |
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Title: | Factors moderating the relative effectiveness of varenicline and nicotine replacement therapy in clients using smoking cessation services |
Location: | England |
Open access status: | An open access version is available from UCL Discovery |
DOI: | 10.1111/add.14004 |
Publisher version: | http://doi.org/10.1111/add.14004 |
Language: | English |
Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
Keywords: | NRT, UK, epidemiological study, smoking cessation, treatment effectiveness, varenicline |
UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health |
URI: | https://discovery.ucl.ac.uk/id/eprint/1571215 |
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