New Clinical Practice Guidelines Recommend Varenicline Over the Patch for Adult Smokers

The American Thoracic Society’s (ATS) new clinical practice guideline on treatment for tobacco dependence in adults addresses how clinicians may deal with patients’ reluctance to quit, according to a press release.

Published in the American Journal of Respiratory and Critical Care Medicine, the latest ATS practice guideline maintains the first principle of clinical practice, that “all patients who use tobacco should receive treatment for their dependence, and not simply be encouraged to stop.”

The guideline expands upon the last guidance by the US Public Health Service, which was issued in 2008. It identifies an optimal controller medication for clinicians to use as an initial pharmacotherapeutic choice and identifies a clinical strategy for amplifying the efficacy of the controller, according to the press release.

“At least among adults, the overwhelming majority of current smokers, including e-cigarette users, express an interest in quitting (over 70%) while only a very few follow through with some attempt," said Frank T. Leone, MD, co-chair of the ATS guideline committee, in a press release.

The following recommendations were formulated using the Grading of Recommendations, Assessment, Development, and Evaluation approach:

1. For tobacco-dependent adults in whom treatment is being initiated, ATS recommends varenicline over a nicotine patch (strong recommendation, moderate certainty in the estimated effects).

2. For tobacco-dependent adults in whom treatment is being initiated, ATS recommends varenicline over bupropion (strong recommendation, moderate certainty in the estimated effects).

3. For tobacco-dependent adults in whom treatment is being initiated, ATS suggests varenicline plus a nicotine patch over varenicline alone (conditional recommendation, low certainty in the estimated effects).

4. For tobacco-dependent adults in whom treatment is being initiated, ATS suggests varenicline over electronic cigarettes (conditional recommendation, very low certainty in the estimated effects).

5. In tobacco-dependent adults who are not ready to discontinue tobacco use, ATS recommends that clinicians begin treatment with varenicline rather than waiting until they are ready to stop tobacco use (strong recommendation, moderate certainty in estimated effects).

6. For tobacco-dependent adults with comorbid psychiatric conditions, including substance use disorder, depression, anxiety, schizophrenia, and/or bipolar disorder, for whom treatment is being initiated, ATS recommend varenicline over a nicotine patch (strong recommendation, moderate certainty in estimated effects).

7. For tobacco-dependent adults for whom treatment is being initiated with a controller, ATS recommends using extended duration, or greater than 12 weeks, over standard duration, or 6-12 weeks (strong recommendation, moderate certainty in estimated effects).

REFERENCE

Experts strongly recommend varenicline over the patch for adult smokers hoping to quit. EurekAlert! https://www.eurekalert.org/pub_releases/2020-07/ats-esr071420.php. Published July 15, 2020. Accessed July 15, 2020.