A study from Harvard bolsters the evidence base for pharmacotherapy to get young people off e-cigarettes.
Varenicline beats placebo in helping young people kick vaping without resorting to tobacco, according to a study that has piqued the interest of the RACGP.
The paper, published in JAMA Network, claims to be the first pharmacotherapy trial for nicotine vaping cessation in young people. It cites research showing that a quarter of Americans aged 18 to 25 have used an e-cigarette in the past month and that half of those who vape in that age group do so daily, and that more than half of those who vape wish to quit.
The team, from Harvard and Massachusetts General Hospital in Boston, took 261 people aged 16 to 25 who had self-reported nicotine vaping five or more days per week in the past few months, did not smoke tobacco, were nicotine-dependent and wanted to quit vaping.
They were randomised to receive over 12 weeks either varenicline (1mg twice daily) plus behavioural counselling, placebo plus behavioural counselling, or “enhanced usual care”, consisting of a referral to This is Quitting, a free text message support program for young people, which all participants received. All participants also received significant financial incentives for completing the program (up to $US570).
Nicotine dependence (a score of at least four on the E-cigarette Dependence Inventory) and saliva cotinine levels were measured weekly for 12 weeks after and three times over a further 12 weeks, when self-reported vaping, tobacco use and other drug use was also recorded.
Biochemically confirmed abstinence in the last four weeks of therapy was the primary outcome; nicotine withdrawal symptoms, craving, and negative mood were secondary outcomes.
Abstinence was 51% in the varenicline group and 14% in the two control groups. After another 12 weeks of follow-up, abstinence rates in both groups had halved.
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The varenicline group also had lower rates of withdrawal severity, craving and distress.
Rates of any adverse event were similar for varenicline and placebo, and nausea, vivid dreaming and insomnia were more common in the varenicline group. A total of eight participants either discontinued or reduced their dosage, and five were smoking tobacco at the end of follow-up, all of whom were also still vaping.
Varenicline is currently approved by the TGA only as a smoking cessation aid for adults, so any prescription for vaping cessation or in minors would be off label.
The latest advice on smoking and vaping cessation from the RACGP, published last October, says there is a lack of evidence for ways to support young people to stop vaping.
“Evidence-based treatments for smoking cessation among adults include pharmacotherapies such as NRT, varenicline, bupropion and cytisine in combination with behavioural support. However, the evidence for their use in vaping cessation is limited, especially in young people.”
The JAMA Network paper says varenicline, a partial a4b2 nicotinic acetylcholine receptor agonist, “has been well tolerated in youth, has demonstrated mixed effects for smoking cessation in youth, and has preliminary evidence for efficacy for vaping cessation in adults”.
“The Royal Australian College of GPs continually updates its advice and guidance based on the latest credible evidence, and medicines for quitting nicotine are no different,” Professor Nick Zwar told Allergy & Respiratory Republic, speaking on behalf of the college.
“This study is welcome as there are very few well-conducted trials on pharmacotherapy options to assist vaping cessation. More than that, the results appear very promising, given that quit rates at both the end of treatment and 24 weeks follow-up points were substantially higher for varenicline compared to a placebo.
“So, the college’s smoking cessation expert advisory group will carefully review the findings. Assisting young people to quit vaping is a high priority, particularly given that we simply don’t know the long-term damage nicotine vaping may cause for many patients.”
