Weight gain following tobacco abstinence is a significant barrier to cessation. Varenicline is the most effective medication for smoking cessation but does not prevent weight gain. Combining sibutramine and varenicline may facilitate smoking abstinence if weight gain is attenuated.
Our aim was to assess the safety and efficacy of sibutramine for weight gain prevention among women quitting smoking with varenicline. Ten smokers enrolled in a pilot study of open-label sibutramine and varenicline for 12 weeks.
Participants rated themselves low on appearance evaluation, health evaluation, health orientation, and body-areas satisfaction. Ninety percent reported that they would return to smoking if they gained weight after stopping smoking. For the 6 subjects who met criteria for prolonged abstinence, weight change from baseline to Week 12 (11 weeks after the target quit date) was 0.2 +/- 1.3 kg, and the 7-day point-prevalence smoking abstinence rate at Week 12 was 70% (95% CI 35%-93%).
Combination therapy with sibutramine and varenicline for weight gain prevention and smoking cessation as an intervention for smokers at risk for relapse to smoking because of weight gain may warrant further investigation.
[Show abstract][Hide abstract] ABSTRACT: People who quit smoking often gain 11-12 lb, on average, which can frequently lead to a relapse to smoking. This study evaluated whether extended vs. standard duration treatment with nicotine patch helps those able to quit smoking to reduce cessation-induced weight gain and explored nicotine patch adherence as a mediator of treatment effects.
We examined data from a completed randomized placebo-controlled clinical trial of extended (24 weeks) vs. standard (8 weeks plus 16 weeks of placebo) transdermal nicotine patch therapy. Changes in measured weight over 24 weeks were compared across the two treatment arms, controlling for gender, baseline smoking rate, and previous weight. Adherence to patch use was assessed using self-report of daily use over 24 weeks.
139 clinical trial participants who were confirmed to be abstinent at weeks 8 and 24.
Compared to participants who received 8 weeks of nicotine patch therapy, participants who received 24 weeks of treatment showed significantly less weight gain from pre-treatment to week 24 (β=-4.76, 95% CI: -7.68 to -1.84, p=.002) and significantly less weight gain from week 8 to week 24 (β=-2.31, 95% CI: -4.39 to -0.23, p=.03). Extended treatment increased patch adherence which, in turn, reduced weight gain; patch adherence accounted for 20% of the effect of treatment arm on weight gain.
Compared to 8 weeks of transdermal nicotine therapy, 24 weeks of patch treatment may help to reduce the weight gain that is typical among smokers who are able to achieve abstinence from tobacco use. Extended treatment increased nicotine patch adherence which, in turn, reduced weight gain.
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