African Americans have been underrepresented in tobacco treatment research, including the clinical trials that led to the 2006 FDA approval of varenicline, the leading pharmacological treatment for smoking cessation commonly known as the brand name Chantix. Meanwhile, African Americans suffer from higher rates of smoking-related disease and death despite smoking fewer cigarettes per day than white Americans.
Researchers from the University of Kansas Cancer Center have published the results of a clinical trial that examined the effectiveness of varenicline in African Americans. In their study published in JAMA, African-American daily smokers who received varenicline while receiving counseling had significantly higher quit rates than those who received a placebo.
Varenicline is really important. We have strong evidence that varenicline is safe and effective for African American smokers. Clinicians need to be proactive in recommending counseling and drug therapy to African Americans, and varenicline can make a big difference in helping individuals quit smoking. »
Lisa Sanderson Cox, PhD, study lead author, professor of population health at the University of Kansas Medical Center and member of the Cancer Prevention and Control Research Program at the University of Kansas Cancer Center
Engage the community
Advancing the treatment of African American smokers to improve health equity was the genesis of a partnership that began 25 years ago between the Medical Center’s Department of Population Health KU, the University of Kansas Cancer Center and Swope Health, a federally licensed health center based in Kansas City. primarily African American patients. This partnership launched the Kick It at Swope (KIS) series of clinical trials, among the few studies in the country designed specifically for African Americans who smoke.
Critical to the success of the KIS trials has been engagement with the community, Dr. Cox said, aided by the trust potential participants have in Swope Health and have earned in the Kick It at Swope program. LaWanda Swoopes, a clinical trial participant, had been a heavy smoker since college. She successfully quit smoking through the Swope program after a colleague who was on the program referred her.
“Normally people watch research on such a large scale, but I think participating is just doing your part,” Swoopes said in a November 2021 episode of Bench to Bedside, a weekly Facebook Live series hosted by the University of Kansas Cancer Center. “That’s what I felt choosing to participate: doing my part to maybe help someone else. They give the opportunity to refer someone, and now I can do my part in the community to help someone quit smoking.”
A critical treatment
The study comes 20 years after the first KIS trial, published in JAMA in 2002, examined the effectiveness of a different, earlier smoking cessation medication for African American adult smokers. The current varenicline study included 500 adults who identified as African American or Black, were 18 years of age or older, were established daily smokers who used at least one cigarette a day, and wanted to quit smoking.
Participants were randomly assigned to receive either varenicline or a placebo for 12 weeks, along with six counseling sessions. The study followed up all participants after six months, with self-reported abstinence verified by saliva samples.
The study showed that after six months, 16% of African American smokers who took varenicline in addition to counseling were still abstinent, while 7% of smokers who received placebo and counseling were successful. to abstain from smoking. At 12 weeks, the difference was even greater: 19% of smokers taking varenicline were abstinent compared to 7% abstinence in the placebo group.
“We saw a two- to three-fold dropout rate between the two groups, and we didn’t see a significant difference between placebo and varenicline in terms of side effects,” Dr. Cox said. “African Americans tend to smoke less but have more disease burden from tobacco use, so treatment is really, really critical.”
Addressing light smokers
In addition to comparing quit rates for the varenicline group versus the placebo group at the 26-week follow-up, the study also looked at the difference in rates for another understudied group: light smokers, defined as smoking 10 cigarettes or less per day. . This subset is particularly relevant to African American smokers, the majority of whom fall into this category.
Previous KIS studies have shown that some African Americans metabolize nicotine more slowly, Dr. Cox said, leading to a need to smoke fewer cigarettes to get the same reward. Societal factors have also led to an increase in the proportion of light smokers, such as the high cost of cigarettes and restrictions on smoking in public spaces and workplaces.
“More people are smoking fewer cigarettes per day, which is fantastic in some ways,” Dr. Cox said. “But even smoking one or two cigarettes a day poses a massive increase in health risks, so we need to find better treatments for light smokers.”
The difference in smoking cessation rates between the varenicline group and the placebo group was particularly pronounced for light smokers compared to moderate and heavy smokers. At the end of week 12, 22% of light smokers who received varenicline were still abstinent, compared to 9% of light smokers in the placebo group, demonstrating that the drug can be useful even for African Americans who smoke a few cigarettes per week. day.
Dr. Cox and his colleagues hope the study can influence clinical practice guidelines for African Americans who want to quit smoking as well as light smokers.
“The goal is to find treatments that work for everyone,” she said. “But the way to research treatments is to realize that a treatment doesn’t work the same way for all individuals.”