ATTUD Journal Club Postings

Repeat quit attempts: Use new therapy or old therapy?

Most smokers who seek individual treatment for smoking cessation have tried to quit in the past and many have already used a behavioral or pharmacological treatment. Assessing why past treatments were used, compliance and perceived benefit of the prior treatment is recommended in most treatment guidelines. However, whether it is best to repeat old treatments or use new treatments is unclear. Several studies have examined re-treatment with the same medication (i.e., recycling). Interestingly, until a recent publication (Heckman, Am J Prev Med 2017, 53:e63) there has not been a comparison of using the same vs a different treatment. This study used data from the large, longitudinal population-based ITC survey of Australian, Canadian, UK, and US smokers collected between 2006-2011; i.e. starting when varenicline became available. The study looked at treatment use at two different times, about 2-3 years apart. The study only reports on pharmacological treatment.

The study found that 11% used the same medication on both quit attempts and 14% used a different medication. Repeaters and switchers were similar in demographics and smoking history. Switchers were more successful than repeaters (29% vs 12%, 1 month non-verified point-prevalence). Some of this appeared to be because switchers were more likely to use varenicline or combination treatments on the second attempt. But even controlling for this, the increase with switching remained.

These results suggest that, unless the smoker has a definite preference for the original treatment, healthcare providers should recommend smokers switch to a different medication/combo of medications, personalized based on each smokers quitting history.