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Varenicline decreases alcohol consumption in heavy-drinking smokers.  

• Anti-Smoking Drug Decreases Alcohol Consumption in Heavy-Drinking Smokers 

The smoking cessation drug varenicline significantly reduced alcohol consumption in a group of heavy-drinking smokers, in a study carried out by researchers at the Ernest Gallo Clinic and Research Center at the University of California, San Francisco.

“Alcohol abuse is a huge problem, and this is a big step forward in identifying a potential new treatment,” said senior author Howard L. Fields, MD, PhD, professor of neurology and director of the Wheeler Center for the Neurobiology of Addiction at UCSF.

The study was published on May 1 in the journal Psychopharmacology.

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• Cardiovascular safety concerns over smoking-cessation drug misleading 

A popular smoking cessation medication has been under a cloud of suspicion ever since the Canadian Medical Association Journal (CMAJ) published a study in July 2011 reporting "risk of serious adverse cardiovascular events associated with varenicline." Varenicline, also known as Chantix, blocks the pleasant effects of nicotine on the smoker's brain and lessens nicotine withdrawal symptoms.

UCSF researchers, however, question the way the previous study was conducted, and their new analysis, scheduled to be published May 4 in BMJ, reaches a very different conclusion.

"We found no clinically or statistically significant increase in serious adverse cardiovascular events associated with using varenicline," said lead author Judith J. Prochaska, PhD, MPH, an associate professor in UCSF's Department of Psychiatry and researcher with the Center for Tobacco Control Research and Education. "The findings from 22 trials with more than 9,200 participants indicate a difference in risk of only 0.27 percent between those on varenicline versus placebo, or about a quarter of one percent."

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KRAMER: Up in Smoke 

Of all the vices I have overindulged in, smoking is the only one I will admit has an addictive spell over me. Only cigarettes — or the lack of them — have changed my personality and taken my body and mind out of my own control. When I was younger and tried to quit, I had horrible physical responses to the nicotine deprivation. Tunnel vision, anxiety attacks, general numbness would take over my body. My wife would often tell me to go out and start smoking again, as she couldn’t bear to watch me fall to pieces.

Since then, quitting has been a constant project with me. I quit all the time. But often, when I am overwhelmed with work, I find it almost impossible to not light up. I know, I know… It’s an excuse. But when I am filled with anxiety I simply find it so much easier to feed the beast. Trying not to smoke takes way too much effort. Of all the vices I have overindulged in, smoking is the only one I will admit has an addictive spell over me. Only cigarettes — or the lack of them — have changed my personality and taken my body and mind out of my own control. When I was younger and tried to quit, I had horrible physical responses to the nicotine deprivation. Tunnel vision, anxiety attacks, general numbness would take over my body. My wife would often tell me to go out and start smoking again, as she couldn’t bear to watch me fall to pieces. . . .

But of course my doctor was concerned about my smoking and wanted to help. He told me about an antidepressant (Bupropion) that had an interesting side effect: it seemed to make cigarettes totally unpalatable. . . .

I found an old pack of cigarettes lying around and I decided to have one to see if it would be as disgusting as the last. It was not.

The cigarette tasted just as good as all the others I’d had before taking the drugs. I laughed out loud to myself and thought, “No wonder I wanted to kill myself. I wasn’t smoking!”

I had my sense of humor back. All was right again with the world. I could live with my anxiety, as long as I had my vices to help me through.

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UC San Diego Researchers Review Cessation Studies and Call for Change in Policy 

In the 2012 edition of the prestigious Annual Review of Public Health, researchers at the University of California, San Diego School of Medicine have reviewed the landscape of smoking cessation over the past 20 years. During this time period, there have been improvements in pharmaceutical medications to aid cessation, and free telephone cessation coaching has become available in every state. However, recent trends in smoking cessation are troubling to tobacco control researchers.

“For the past decade, attempts to quit smoking have increased, but the proportion of people who become successful quitters has gone down” said John P. Pierce, PhD, professor of Family and Preventive Medicine and director of Population Sciences at UC San Diego Moores Cancer Center. “Widespread dissemination of cessation services has not led to an increase in the probability that a quit attempt will be successful."

The problem does not appear to be with the cessation services themselves. “ . . .

recent evidence suggests that part of the problem may lie in how cessation aids are marketed by pharmaceutical companies: many such ads suggest that quitting smoking may be as simple as putting on a patch. It appears that younger smokers in particular are now more likely to underestimate the amount of work needed in order to quit smoking successfully. . . .

Pierce and colleagues noted that some of the earliest texts in psychology – written more than 100 years ago – include chapters on breaking habits such as smoking. In 1890, William James laid out a series of maxims that were widely recognized then and that still hold true today: smokers need to make a strong resolution to change; they need to act quickly on that resolution; they will be more successful if they make a personal commitment to another to be successful; and finally, it is important to understand the danger of having even a single cigarette during a quit attempt.

The researchers suggest that policy makers join those in academia for a serious review of tobacco cessation policy.

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Smoking Cessation Worth It Despite Dim Outcomes  

Action Points

* Drugs and counseling to help patients stop smoking typically double the odds of success relative to solo cold-turkey attempts, but success rates still seldom exceed 20%.

* Point out that so-called electronic cigarettes may not actually reduce the harm of smoking, are largely unregulated devices, and without evidence of their long-term health effects at present.

NEW ORLEANS -- Drugs and counseling to help patients stop smoking typically double the odds of success relative to solo cold-turkey attempts, but success rates still seldom exceed 20%, a researcher said here.

The bottom-line message: "Keep trying," said Michael K. Ong, MD, PhD, of the University of California Los Angeles, in a presentation at the American College of Physicians' annual meeting.

Existing approaches to smoking cessation will remain the best available for the foreseeable future, Ong suggested, and even though their effectiveness is modest at best, they are better than letting patients fend for themselves.

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• Smoking Cessation Worth It Despite Dim Outcomes  

Action Points

* Drugs and counseling to help patients stop smoking typically double the odds of success relative to solo cold-turkey attempts, but success rates still seldom exceed 20%.

* Point out that so-called electronic cigarettes may not actually reduce the harm of smoking, are largely unregulated devices, and without evidence of their long-term health effects at present.

NEW ORLEANS -- Drugs and counseling to help patients stop smoking typically double the odds of success relative to solo cold-turkey attempts, but success rates still seldom exceed 20%, a researcher said here.

The bottom-line message: "Keep trying," said Michael K. Ong, MD, PhD, of the University of California Los Angeles, in a presentation at the American College of Physicians' annual meeting.

Existing approaches to smoking cessation will remain the best available for the foreseeable future, Ong suggested, and even though their effectiveness is modest at best, they are better than letting patients fend for themselves.

He noted that clinicians are often reluctant to assist patients with these problems.

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Federal judge sets dates for first two trials against Pfizer over Chantix stop-smoking drug 

• Duluth Woman's Chantix Suit May Be Nation's First 

A federal judge in north Alabama has set the first two trials stemming from thousands of lawsuits filed nationwide against pharmaceutical manufacturer Pfizer over its stop-smoking product Chantix.

The United States Judicial Panel on Multistate Litigation consolidated the Chantix suits and assigned them to U.S. District Judge Inge Johnson.

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Early Study Finds Some Promise for Lung Cancer Vaccine 

A new therapeutic vaccine appears to lengthen the lives of patients with a certain type of lung cancer, according to results of a small phase 2 trial.

The drug, belagenpumatucel-L (Lucanix), extended the lives of patients with nonprogressive non-small cell lung cancer and increased the five-year survival rate among some patients with moderately advanced cancer to 50 percent, researchers found.

For the study, 75 patients with stage 2, 3A, 3B or 4 cancer were randomly assigned to various doses of the vaccine, which was derived from four lung cancer cell lines. Staging refers to the severity of cancer. A stage 3 cancer has spread nearby, while a stage 4 cancer has spread to another organ.

Overall, the patients survived an average of 14.5 months and the five-year survival rate was 20 percent, lead researcher Dr. Lyudmila Bazhenova, an associate clinical professor at the University of California, San Diego Moores Cancer Center in La Jolla, and colleagues noted.

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Possible Medication Re-Branding for Smokers 

Smoking cessation drug improves walking function in patients with spinocerebellar ataxia type 3 

A nicotinic drug approved for smoking cessation significantly improved the walking ability of patients suffering from an inherited form of ataxia, reports a new clinical study led by University of South Florida researchers.

The randomized controlled clinical trial investigated the effectiveness of varenicline (Chantix®) in treating spinocerebellar ataxia type 3, or SCA3. The findings were published online earlier this month in Neurology, the journal of the American Academy of Neuroscience.

Lead author Dr. Theresa Zesiewicz and colleagues at the USF Ataxia Research Center collaborated with researchers from Beth Israel Deaconess Medical Center in Boston, MA, and from the David Geffen School of Medicine at UCLA in Los Angeles, CA.

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• Smoking makes men dumber  

Researchers at University College London led by Sverine Sabia crunched the data from long-term studies of current smokers, ex-smokers and never-smokers, ranging in age from 44 to 69. The subjects were white-collar British civil servants, followed over a 25-year period.

They were tested for short-term memory, vocabulary, verbal and mathematical reasoning. In men, smoking was associated with a faster decline over a 10-year period, equivalent to an additional 10 years of aging. However, Sabia writes, “our results show no association between smoking and cognitive decline in women.”

Sabia notes that, on average, women smoke fewer cigarettes per day than men, and men drink more alcohol. Also, “it is also possible that smoking clusters with other risk factors differently in men and women.”

One piece of good news emerging from this study is that men who had quit smoking at least 10 years ago didn’t suffer the same cognitive decline, and “no residual adverse effect of smoking on cognitive decline was observable.”

In fact, long-term quitters scored slightly higher than men who had never smoked. One possible explanation is that when people stop smoking, they often go on a health kick.

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Would vaccination against nicotine be a cost-effective way to prevent smoking uptake in adolescents?  

Findings

Under the most optimistic assumptions, the cost to avert a smoker at age 20 was $44 431 [95% confidence interval (CI) $40 023–49 250]. This increased to $296 019 (95% CI $252 307–$355 930) under more plausible scenarios. The vaccine programme was not cost-effective under any scenario.

Conclusions

A preventive nicotine vaccination programme is unlikely to be cost-effective. The total cost of a universal vaccination programme would be high and its impact on population smoking prevalence negligible. For these reasons, such a programme is unlikely to be publicly funded in Australia or any other developed country.

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• Broad anti-smoking vaccination not worth cost: study  

A vaccination campaign to prevent teenagers from taking up smoking would be too expensive to recommend, according to Australian researchers who looked at the costs and benefits of anti-nicotine shots in development.

Taking into account the effectiveness demonstrated so far by experimental vaccines designed to help smokers quit, the team concluded the drugs would need to be cheaper, require fewer doses and get better results for widespread preventive vaccination of teens to be worthwhile.

"On the data that is currently available on NicVax and other nicotine vaccines these scenarios are unrealistic," said Coral Gartner, a researcher at the University of Queensland who led the study.

No anti-smoking vaccines are on the market yet, but several have been tested in humans. NicVax, being developed by Nabi Pharmaceuticals, is one for which trial results have been published -- but it didn't appear to help people quit smoking.

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