Cardiovascular safety of varenicline, bupropion, and nicotine patch in smokers a randomized clinical trial

Neal L. Benowitz, Andrew Pipe, Robert West, James Taylor Hays, Serena Tonstad, Thomas McRae, David Lawrence, Lisa St Aubin, Robert M. Anthenelli

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

IMPORTANCE Quitting smoking is enhanced by the use of pharmacotherapies, but concerns have been raised regarding the cardiovascular safety of such medications. OBJECTIVE To compare the relative cardiovascular safety risk of smoking cessation treatments. DESIGN, SETTING, AND PARTICIPANTS A double-blind, randomized, triple-dummy, placeboand active-controlled trial (Evaluating Adverse Events in a Global Smoking Cessation Study [EAGLES]) and its nontreatment extension trial was conducted at 140 multinational centers. Smokers, with or without established psychiatric diagnoses, who received at least 1 dose of study medication (n = 8058), as well as a subset of those who completed 12 weeks of treatment plus 12 weeks of follow up and agreed to be followed up for an additional 28 weeks (n = 4595), were included. INTERVENTIONS Varenicline, 1mg twice daily; bupropion hydrochloride, 150mg twice daily; and nicotine replacement therapy, 21-mg/d patch with tapering. MAIN OUTCOMES AND MEASURES The primary end pointwas the time to development of a major adverse cardiovascular event (MACE: cardiovascular death, nonfatalmyocardial infarction, or nonfatal stroke) during treatment; secondary end points were the occurrence of MACE and other pertinent cardiovascular events (MACE+: MACE or new-onset or worsening peripheral vascular disease requiring intervention, coronary revascularization, or hospitalization for unstable angina). RESULTS Of the 8058 participants, 3553 (44.1%) were male (mean [SD] age, 46.5 [12.3] years). The incidence of cardiovascular events during treatment and follow-up was low (<0.5%for MACE; <0.8%forMACE+) and did not differ significantly by treatment. No significant treatment differences were observed in time to cardiovascular events, blood pressure, or heart rate. There was no significant difference in time to onset ofMACE for either varenicline or bupropion treatment vs placebo (varenicline: hazard ratio, 0.29; 95%CI, 0.05-1.68 and bupropion: hazard ratio, 0.50; 95%CI, 0.10-2.50). CONCLUSIONS AND RELEVANCE No evidence that the use of smoking cessation pharmacotherapies increased the risk of serious cardiovascular adverse events during or after treatment was observed. The findings of EAGLES and its extension trial provide further evidence that smoking cessation medications do not increase the risk of serious cardiovascular events in the general population of smokers.

Original languageEnglish (US)
Pages (from-to)622-631
Number of pages10
JournalJAMA Internal Medicine
Volume178
Issue number5
DOIs
StatePublished - May 1 2018

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Tobacco Use Cessation Products
Bupropion
Randomized Controlled Trials
Smoking Cessation
Safety
Therapeutics
Drug Therapy
Withholding Treatment
Peripheral Vascular Diseases
Varenicline
Unstable Angina
Nicotine
Mental Disorders
Infarction
Hospitalization
Heart Rate
Smoking
Stroke
Placebos
Blood Pressure

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Cardiovascular safety of varenicline, bupropion, and nicotine patch in smokers a randomized clinical trial. / Benowitz, Neal L.; Pipe, Andrew; West, Robert; Hays, James Taylor; Tonstad, Serena; McRae, Thomas; Lawrence, David; St Aubin, Lisa; Anthenelli, Robert M.

In: JAMA Internal Medicine, Vol. 178, No. 5, 01.05.2018, p. 622-631.

Research output: Contribution to journalArticle

Benowitz, NL, Pipe, A, West, R, Hays, JT, Tonstad, S, McRae, T, Lawrence, D, St Aubin, L & Anthenelli, RM 2018, 'Cardiovascular safety of varenicline, bupropion, and nicotine patch in smokers a randomized clinical trial', JAMA Internal Medicine, vol. 178, no. 5, pp. 622-631. https://doi.org/10.1001/jamainternmed.2018.0397
Benowitz, Neal L. ; Pipe, Andrew ; West, Robert ; Hays, James Taylor ; Tonstad, Serena ; McRae, Thomas ; Lawrence, David ; St Aubin, Lisa ; Anthenelli, Robert M. / Cardiovascular safety of varenicline, bupropion, and nicotine patch in smokers a randomized clinical trial. In: JAMA Internal Medicine. 2018 ; Vol. 178, No. 5. pp. 622-631.
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abstract = "IMPORTANCE Quitting smoking is enhanced by the use of pharmacotherapies, but concerns have been raised regarding the cardiovascular safety of such medications. OBJECTIVE To compare the relative cardiovascular safety risk of smoking cessation treatments. DESIGN, SETTING, AND PARTICIPANTS A double-blind, randomized, triple-dummy, placeboand active-controlled trial (Evaluating Adverse Events in a Global Smoking Cessation Study [EAGLES]) and its nontreatment extension trial was conducted at 140 multinational centers. Smokers, with or without established psychiatric diagnoses, who received at least 1 dose of study medication (n = 8058), as well as a subset of those who completed 12 weeks of treatment plus 12 weeks of follow up and agreed to be followed up for an additional 28 weeks (n = 4595), were included. INTERVENTIONS Varenicline, 1mg twice daily; bupropion hydrochloride, 150mg twice daily; and nicotine replacement therapy, 21-mg/d patch with tapering. MAIN OUTCOMES AND MEASURES The primary end pointwas the time to development of a major adverse cardiovascular event (MACE: cardiovascular death, nonfatalmyocardial infarction, or nonfatal stroke) during treatment; secondary end points were the occurrence of MACE and other pertinent cardiovascular events (MACE+: MACE or new-onset or worsening peripheral vascular disease requiring intervention, coronary revascularization, or hospitalization for unstable angina). RESULTS Of the 8058 participants, 3553 (44.1{\%}) were male (mean [SD] age, 46.5 [12.3] years). The incidence of cardiovascular events during treatment and follow-up was low (<0.5{\%}for MACE; <0.8{\%}forMACE+) and did not differ significantly by treatment. No significant treatment differences were observed in time to cardiovascular events, blood pressure, or heart rate. There was no significant difference in time to onset ofMACE for either varenicline or bupropion treatment vs placebo (varenicline: hazard ratio, 0.29; 95{\%}CI, 0.05-1.68 and bupropion: hazard ratio, 0.50; 95{\%}CI, 0.10-2.50). CONCLUSIONS AND RELEVANCE No evidence that the use of smoking cessation pharmacotherapies increased the risk of serious cardiovascular adverse events during or after treatment was observed. The findings of EAGLES and its extension trial provide further evidence that smoking cessation medications do not increase the risk of serious cardiovascular events in the general population of smokers.",
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AU - Benowitz, Neal L.

AU - Pipe, Andrew

AU - West, Robert

AU - Hays, James Taylor

AU - Tonstad, Serena

AU - McRae, Thomas

AU - Lawrence, David

AU - St Aubin, Lisa

AU - Anthenelli, Robert M.

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N2 - IMPORTANCE Quitting smoking is enhanced by the use of pharmacotherapies, but concerns have been raised regarding the cardiovascular safety of such medications. OBJECTIVE To compare the relative cardiovascular safety risk of smoking cessation treatments. DESIGN, SETTING, AND PARTICIPANTS A double-blind, randomized, triple-dummy, placeboand active-controlled trial (Evaluating Adverse Events in a Global Smoking Cessation Study [EAGLES]) and its nontreatment extension trial was conducted at 140 multinational centers. Smokers, with or without established psychiatric diagnoses, who received at least 1 dose of study medication (n = 8058), as well as a subset of those who completed 12 weeks of treatment plus 12 weeks of follow up and agreed to be followed up for an additional 28 weeks (n = 4595), were included. INTERVENTIONS Varenicline, 1mg twice daily; bupropion hydrochloride, 150mg twice daily; and nicotine replacement therapy, 21-mg/d patch with tapering. MAIN OUTCOMES AND MEASURES The primary end pointwas the time to development of a major adverse cardiovascular event (MACE: cardiovascular death, nonfatalmyocardial infarction, or nonfatal stroke) during treatment; secondary end points were the occurrence of MACE and other pertinent cardiovascular events (MACE+: MACE or new-onset or worsening peripheral vascular disease requiring intervention, coronary revascularization, or hospitalization for unstable angina). RESULTS Of the 8058 participants, 3553 (44.1%) were male (mean [SD] age, 46.5 [12.3] years). The incidence of cardiovascular events during treatment and follow-up was low (<0.5%for MACE; <0.8%forMACE+) and did not differ significantly by treatment. No significant treatment differences were observed in time to cardiovascular events, blood pressure, or heart rate. There was no significant difference in time to onset ofMACE for either varenicline or bupropion treatment vs placebo (varenicline: hazard ratio, 0.29; 95%CI, 0.05-1.68 and bupropion: hazard ratio, 0.50; 95%CI, 0.10-2.50). CONCLUSIONS AND RELEVANCE No evidence that the use of smoking cessation pharmacotherapies increased the risk of serious cardiovascular adverse events during or after treatment was observed. The findings of EAGLES and its extension trial provide further evidence that smoking cessation medications do not increase the risk of serious cardiovascular events in the general population of smokers.

AB - IMPORTANCE Quitting smoking is enhanced by the use of pharmacotherapies, but concerns have been raised regarding the cardiovascular safety of such medications. OBJECTIVE To compare the relative cardiovascular safety risk of smoking cessation treatments. DESIGN, SETTING, AND PARTICIPANTS A double-blind, randomized, triple-dummy, placeboand active-controlled trial (Evaluating Adverse Events in a Global Smoking Cessation Study [EAGLES]) and its nontreatment extension trial was conducted at 140 multinational centers. Smokers, with or without established psychiatric diagnoses, who received at least 1 dose of study medication (n = 8058), as well as a subset of those who completed 12 weeks of treatment plus 12 weeks of follow up and agreed to be followed up for an additional 28 weeks (n = 4595), were included. INTERVENTIONS Varenicline, 1mg twice daily; bupropion hydrochloride, 150mg twice daily; and nicotine replacement therapy, 21-mg/d patch with tapering. MAIN OUTCOMES AND MEASURES The primary end pointwas the time to development of a major adverse cardiovascular event (MACE: cardiovascular death, nonfatalmyocardial infarction, or nonfatal stroke) during treatment; secondary end points were the occurrence of MACE and other pertinent cardiovascular events (MACE+: MACE or new-onset or worsening peripheral vascular disease requiring intervention, coronary revascularization, or hospitalization for unstable angina). RESULTS Of the 8058 participants, 3553 (44.1%) were male (mean [SD] age, 46.5 [12.3] years). The incidence of cardiovascular events during treatment and follow-up was low (<0.5%for MACE; <0.8%forMACE+) and did not differ significantly by treatment. No significant treatment differences were observed in time to cardiovascular events, blood pressure, or heart rate. There was no significant difference in time to onset ofMACE for either varenicline or bupropion treatment vs placebo (varenicline: hazard ratio, 0.29; 95%CI, 0.05-1.68 and bupropion: hazard ratio, 0.50; 95%CI, 0.10-2.50). CONCLUSIONS AND RELEVANCE No evidence that the use of smoking cessation pharmacotherapies increased the risk of serious cardiovascular adverse events during or after treatment was observed. The findings of EAGLES and its extension trial provide further evidence that smoking cessation medications do not increase the risk of serious cardiovascular events in the general population of smokers.

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