Smoking Cessation Pharmacotherapy Efficacy in Comorbid Medical Populations: Secondary Analysis of the EAGLES Randomized Clinical Trial
Abstract
INTRODUCTION
This study sought to compare medication efficacy in participants with medical comorbidities who smoke in the EAGLES trial, a double-blind, triple-dummy, placebo- and active-controlled RCT.
METHODS
Participants were from the US cohort of the main trial and randomized (1:1:1:1) to varenicline, bupropion, NRT patch, or placebo for 12 weeks with follow-up through week 24. Medical comorbidity data were derived from the baseline medical screening questionnaire and categorized into 4 subgroups (cardiac, respiratory, vascular, diabetes). Within each comorbidity, generalized linear mixed models were used to assess the association between treatment and continuous abstinence rates from Weeks 9-12 and 9-24. Similar models were used to test the effect of number of comorbidities on abstinence.
RESULTS
Varenicline resulted in the highest Week 12 abstinence rates across all pharmacotherapies and compared to placebo in all comorbidity subgroups: cardiac (40.0% vs 3.6%; OR=23.3 [5.1-107.1]), respiratory (24.7% vs 12.8%; OR=2.2 [1.3-3.8]), vascular (29.1% vs 10.4%; OR=3.6 [2.3-5.7), and diabetes (30.9% vs. 8.3%; OR=6.5 [2.3-19.0]). This was maintained at Week 24 for those with cardiac (23.3% vs 1.8%; OR=21.7 [2.7-178.2]), vascular (18.9% vs 7.1%; OR=3.1 [1.8-5.3]), and diabetes (20.6% vs 4.2%; OR=8.4 [2.1-33.7]) comorbidities. Treatment contrasts within some comorbidity subgroups revealed superior efficacy of varenicline over other pharmacotherapies. All pharmacotherapies…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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