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A Smoking Intervention Study Using Scheduled Gradual Reduction With Varenicline to Help With Cessation

Information source: Icahn School of Medicine at Mount Sinai
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Nicotine Addiction

Intervention: Scheduled Gradual Reduction + Varenicline (Other); Scheduled Gradual Reduction + Placebo Drug (Other); Basic Advice + Varenicline (Other); Basic Advice + Placebo Drug (Other)

Phase: Phase 4

Status: Recruiting

Sponsored by: Icahn School of Medicine at Mount Sinai

Official(s) and/or principal investigator(s):
Joel Erblich, Ph.D, Principal Investigator, Affiliation: Icahn School of Medicine at Mount Sinai

Overall contact:
Alexandra Michalowski, BA, Phone: 212-824-7820, Email: alexandra.michalowski@mssm.edu

Summary

This study has three main aims. Aim 1: To provide initial data on the efficacy of combined Scheduled Gradual Reduction (SGR) and Varenicline (VN) for smoking cessation, by assessing abstinence and levels of smoking at 2 time points (4 and 12 weeks post quit). Aim 2: To explore the possibility that SGR+VN will be particularly efficacious among smokers with higher background levels of Cue Reactivity (CR), as assessed at the start of the study, using a classic experimental smoking CR paradigm. Aim 3: To explore possible mechanisms underlying the effects of SGR+VN, by assessing potential mediators (i. e., self-efficacy, cue-induced cravings) of treatment effects.

Clinical Details

Official title: A Combination of Scheduled Reduced Smoking With Varenicline to Enhance Cessation

Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Factorial Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment

Primary outcome: Comparison of Prolonged Abstinence

Secondary outcome:

Comparison of Continuous Abstinence

Comparison of Survival

Detailed description: Smoking remains an intransigent public health concern. There is ample evidence that non-pharmacological factors, such as environmental triggers (e. g., sight or smell of a cigarette), can give rise to strong classically-conditioned urges to smoke (termed 'cue-reactivity' [CR]), and that exposure to smoking cues can contribute to cessation failure. One promising intervention that may address CR is scheduled smoking with gradual reduction (SGR). Under SGR, individuals smoke only at fixed intervals, and over several weeks, systematically decrease their cigarettes consumed each day. The approach is postulated to: 1) provide 'practice' coping with environmentally-triggered cravings that occur during the inter-cigarette intervals, yielding increased self-efficacy to quit, and 2) weaken the associations between cues and smoking. Accumulating evidence has also shown that the smoking cessation drug, varenicline (VN), substantially ameliorates cravings and enhances cessation, significantly outperforming other drugs. Interestingly, recent animal research suggests that VN may operate at least partially by dampening conditioned drug cravings. A combination therapy consisting of SGR+VN might thus lead to significantly enhanced cessation, simultaneously attacking cravings using both pharmacological and non-pharmacological approaches. Because the beneficial effects of SGR and VN may be at least partially due to enhanced management of conditioned cravings, it is possible that that they will be particularly efficacious for smokers with high levels of CR. Using both laboratory experimental techniques and a prospective intervention design in this R34 application, we propose to provide initial data to: 1) test the hypothesis that a combination of SGR+VN will enhance cessation, 2) explore the possibility that SGR and VN might be particularly efficacious among smokers with higher levels of CR, and 3) explore potential mechanisms underlying treatment effects. Findings from this study would set the stage for larger efficacy and effectiveness trials of SGR alone and in conjunction with VN, as well as efforts to target SGR and/or VN toward the subgroups that would benefit the most (e. g., smokers with high levels of CR, carriers of specific smoking-related genotypes).

Eligibility

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Current cigarette smoker

- Averages at least 10 cigarettes/day for 5 or more years

- DSM-IV diagnosis of Nicotine Dependence

- Breath carbon monoxide > 6 ppm

- Motivated to quit: score > 8 on Contemplation Ladder

- Age > 18 years

Exclusion Criteria:

- Current illicit substance use

- Other tobacco use (e. g., cigar, pipe)

- History of psychosis

- Past or current cardiovascular disease

- Impaired renal functioning

- Pregnancy

- Nursing

- Current treatment for smoking cessation

- Clinically significant depressive symptoms (CES-D > 16)

- Current suicidal ideation

Locations and Contacts

Alexandra Michalowski, BA, Phone: 212-824-7820, Email: alexandra.michalowski@mssm.edu

Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States; Recruiting
Joel Erblich, Ph.D, Principal Investigator
Additional Information

Starting date: December 2012
Last updated: April 16, 2015

Page last updated: August 23, 2015

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