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Smokers seeking to conquer their addiction may have a new treatment option following the results from a clinical trial conducted at Barwon Health and other public hospitals, which found a combination of varenicline and nicotine lozenges significantly improved smoking abstinence when compared with varenicline alone.

Both varenicline and nicotine lozenges (a form of nicotine replacement therapy) are medications commonly used for smoking cessation. Varenicline, marketed in Australia as Champix, is the most effective single therapy currently available for smoking cessation.

The ‘VANISH’ (Varenicline And NIcotine replacement therapy for Smokers admitted to Hospitals) Trial included 320 adult daily smokers across five Australian public hospitals. It found that participants treated with both varenicline and nicotine lozenges had 84 per cent greater odds (chance) to abstain from smoking when self-reporting their progress at a 12-month follow up, compared with those taking varenicline alone. 

The multi-institutional study was led by Monash University’s Centre for Medicine Use and Safety (CMUS) in collaboration with other leading research institutes and five major Australian tertiary care public hospitals, coordinated by Barwon Health. 

Dr Greg Weeks (pictured), Director of Pharmacy at Barwon Health, researcher and first author of the study, said "Pharmacists at Barwon Health played a major role in the VANISH study, including randomising participants, providing logistical support to hospitals and recruiting 104 of the 320 participants."

Associate Professor Johnson George, author of the study and smoking cessation expert from CMUS, said “The COVID-19 pandemic limited our ability to measure biochemically validated abstinence; however, based on self-reported abstinence, the combination therapy was clearly the more effective option when compared with varenicline alone, with no compromise on safety,”

“As such, in the context of heavy smokers who continue to experience withdrawal symptoms when taking varenicline alone, based on our findings it is certainly worth considering introducing nicotine lozenges to their treatment regimen.”

Smoking is the leading cause of preventable disease and death in Australia. While the number of people smoking tobacco cigarettes has dramatically dropped over recent decades, concurrently a new generation of nicotine addiction has escalated due to the introduction of e-cigarettes and vaping. 

“Vaping is highly addictive and has become extremely prevalent, particularly among teenagers. However, no matter how old you are there is no place for vaping as an evidence-based smoking cessation strategy in the management of nicotine dependence,” said Associate Professor George.

“Taking this into account, the more alternative options we can provide smokers that do not involve vaping, the better.” 

The researchers targeted hospitalised heavy smokers due to how much they would benefit greatly from smoking cessation, also leading to greater benefits to the community and healthcare systems. 

This paper has been published in JAMA Network Open. Click here to read.

Weeks GR, Gobarani RK, Abramson MJ, et al. Varenicline and Nicotine Replacement Therapy for Smokers Admitted to Hospitals: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(6):e2418120. doi:10.1001/jamanetworkopen.2024.18120