A Phase 4 interventional study of Varenicline and BASC in Nicotine Dependence and Major Depressive Disorder, sponsored by Northwestern University. Completed at 2 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-07-29.
Sponsored by Northwestern University · Phase 4, Interventional, and Treatment
Persons who struggle with depression smoke at high rates and experience low quit rates in treatment. The best way to improve cessation treatment for this underserved population remains unknown. The proposed trial tests whether the combination of varenicline and behavioral mood management treatment enhances long-term abstinence for depressed smokers and, if so, whether this treatment achieves its effects through addressing the unique psychological factors that appear to maintain tobacco dependence for these smokers.
Upwards of 43% of persons with major depressive disorder (MDD) are daily smokers who are more likely to smoke heavily, show greater tobacco dependence, suffer more severe withdrawal, and experience lower quit rates than smokers without MDD. Little is known about treatment strategies that might optimize smoking cessation for smokers with MDD because almost all randomized clinical trials have excluded these smokers. This project answers many prominent but largely unanswered calls over the last decade to address tobacco dependence in persons with mental health disorders, especially major depressive disorder (MDD). Using a double-blind, placebo-controlled, randomized design, the investigators will evaluate the efficacy of behavioral activation for smoking cessation (BASC) plus varenicline for treating tobacco dependence in smokers with current or lifetime MDD. Three hundred and thirty daily (≥1 cigarettes/day) smokers will be randomized to receive 12 weeks of one of four treatments: 1) Standard behavioral cessation treatment (ST) + placebo; 2) Behavioral activation integrated with ST (BASC) + placebo; 3) ST + varenicline; or 4) BASC + varenicline. Both BASC and ST will be administered in eight 45 minute sessions, occurring weekly for the first four weeks and biweekly for the final eight weeks. Randomization will be stratified on clinical site (Northwestern, University of Pennsylvania), gender, and severity of depressive symptoms (minimal/mild vs. moderate/severe). The primary outcomes will be carbon monoxide (CO) verified 7-day point prevalence abstinence at 24-weeks post-quit. Additional aims include assessing adverse event rates between varenicline and placebo arms, and testing for mediation of treatment effects by anhedonia, cognitive function (attention and memory), cigarette reward value, and craving and withdrawal. This randomized controlled trial will be the first adequately powered trial of BASC in this population; the first trial to evaluate varenicline among a community sample of smokers with MDD; and the first trial to assess the main and combined effects of these two treatments.
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Exclusion criteria:
Standard behavioral smoking cessation treatment plus placebo varenicline
Behavioral: Standard treatment
Behavioral activation for smoking cessation plus placebo varenicline
Behavioral: BASC
Standard behavioral smoking cessation treatment plus active varenicline
Drug: Varenicline · Behavioral: Standard treatment
Behavioral activation for smoking cessation plus active varenicline
Drug: Varenicline · Behavioral: BASC
Participants will be randomly assigned to 12 weeks of either placebo or varenicline medication (1mg twice daily). Participants and research personnel will be blind to treatment assignment.
Also known as: Chantix
The goal of behavioral activation therapy is to increase engagement in rewarding activities, a problem for smokers with depression who find smoking especially rewarding and prefer it over many other traditionally rewarding activities, by reducing patterns of behavioral avoidance, withdrawal, and inactivity. In this study, behavioral activation will be integrated with standard behavioral smoking cessation treatment. Treatment will be delivered in eight 45-minute sessions over 12 weeks occurring weekly for the first four sessions and biweekly for the final four sessions.
Also known as: Behavioral activation for smoking cessation
Standard behavioral smoking cessation treatment is an effective treatment for nicotine dependence. Treatment focuses on self-monitoring of smoking behavior, identifying smoking triggers and alternative trigger management strategies, relaxation, social support for non-smoking, and relapse prevention. Treatment will be delivered in eight 45-minute sessions over 12 weeks occurring weekly for the first four sessions and biweekly for the final four sessions.
Also known as: Standard Therapy
Bioverified Point-prevalence Abstinence at 27 Weeks
Participants were classified as abstinent if they reported abstinence, not even a puff of a cigarette, for \>7 days prior to week 27 (24 weeks post-target quit date) and had an expired carbon monoxide reading of ≤ 6 parts per million at week 27.
Time frame: 27 weeks (24-weeks post-target quit date)
Adverse Event and Serious Adverse Event Rates
Adverse event and serious adverse event rates between varenicline and placebo arms. A previously developed algorithm was used to classify side effect reports as adverse events (AEs) or serious adverse events (SAEs) (Schnoll et al. 2019). Reference: Schnoll, R., Leone, F., Weisbrot, J., Veluz-Wilkins, A., Miele, A., Hole, A., Jao, N.C., Wileyto, E.P., Carroll, A.J., Kalhan, R., Patel, J., Langer, C., \& Hitsman, B. (2019). A randomized controlled trial of 24-weeks of varenicline for tobacco use among cancer patients: Efficacy, safety, and adherence. Psycho-Oncology, 28, 561-569.
Time frame: Weeks 1 (1-week before starting medication), 6, and 14 (end of medication)
Bioverified Point-prevalence Abstinence at 14 Weeks (End of Treatment)
Participants were classified as abstinent if they reported abstinence, not even a puff of a cigarette, for \>7 days prior to week 14 (11-weeks post-target quit date) and had an expired carbon monoxide reading of ≤ 6 parts per million at week 14.
Time frame: 14 weeks (11-weeks post-target quit date)
Prolonged Abstinence
\<7 consecutive days of self-reported smoking after a 2-week grace period
Time frame: 27 weeks (24 weeks post target quit date)
Continuous Abstinence
No smoking between target quit date (week 3) and week 27
Time frame: 27 weeks (24 weeks post target quit date)
Time to 7-day Relapse
Time to relapse as defined by 7 or more consecutive days of self-reported smoking (no grace period)
Time frame: 27 weeks (24 weeks post target quit date)
| Milestone | Standard Treatment + Placebo Varenicline | BASC + Placebo Varenicline | Standard Treatment + Active Varenicline | BASC + Active Varenicline |
|---|---|---|---|---|
| Started | 68 | 68 | 81 | 83 |
| Completed | 39 | 29 | 51 | 51 |
| Not completed | 29 | 39 | 30 | 32 |
Participants were classified as abstinent if they reported abstinence, not even a puff of a cigarette, for \>7 days prior to week 27 (24 weeks post-target quit date) and had an expired carbon monoxide reading of ≤ 6 parts per million at week 27.
| Participants | Standard Treatment + Placebo Varenicline | BASC + Placebo Varenicline | Standard Treatment + Active Varenicline | BASC + Active Varenicline |
|---|---|---|---|---|
| Bioverified Point-prevalence Abstinence at 27 Weeks | 6 | 3 | 13 | 13 |
Adverse event and serious adverse event rates between varenicline and placebo arms. A previously developed algorithm was used to classify side effect reports as adverse events (AEs) or serious adverse events (SAEs) (Schnoll et al. 2019). Reference: Schnoll, R., Leone, F., Weisbrot, J., Veluz-Wilkins, A., Miele, A., Hole, A., Jao, N.C., Wileyto, E.P., Carroll, A.J., Kalhan, R., Patel, J., Langer, C., \& Hitsman, B. (2019). A randomized controlled trial of 24-weeks of varenicline for tobacco use among cancer patients: Efficacy, safety, and adherence. Psycho-Oncology, 28, 561-569.
| Participants | Placebo - Week 1 | Varenicline - Week 1 | Placebo - Week 6 | Varenicline - Week 6 | Placebo - Week 14 | Varenicline - Week 14 |
|---|---|---|---|---|---|---|
| Any adverse event | 104 | 136 | 68 | 81 | 50 | 60 |
| Any serious adverse event | 28 | 34 | 26 | 22 | 9 | 8 |
Participants were classified as abstinent if they reported abstinence, not even a puff of a cigarette, for \>7 days prior to week 14 (11-weeks post-target quit date) and had an expired carbon monoxide reading of ≤ 6 parts per million at week 14.
| Participants | Standard Treatment + Placebo Varenicline | BASC + Placebo Varenicline | Standard Treatment + Active Varenicline | BASC + Active Varenicline |
|---|---|---|---|---|
| Bioverified Point-prevalence Abstinence at 14 Weeks (End of Treatment) | 8 | 4 | 26 | 26 |
\<7 consecutive days of self-reported smoking after a 2-week grace period
| Participants | Standard Treatment + Placebo Varenicline | BASC + Placebo Varenicline | Standard Treatment + Active Varenicline | BASC + Active Varenicline |
|---|---|---|---|---|
| Prolonged Abstinence | 13 | 11 | 26 | 26 |
No smoking between target quit date (week 3) and week 27
| Participants | Standard Treatment + Placebo Varenicline | BASC + Placebo Varenicline | Standard Treatment + Active Varenicline | BASC + Active Varenicline |
|---|---|---|---|---|
| Continuous Abstinence | 3 | 2 | 6 | 2 |
Time to relapse as defined by 7 or more consecutive days of self-reported smoking (no grace period)
| median days to relapse | Standard Treatment + Placebo Varenicline | BASC + Placebo Varenicline | Standard Treatment + Active Varenicline | BASC + Active Varenicline |
|---|---|---|---|---|
| Time to 7-day Relapse | 15 (15 to 16) | 15 (15 to 22) | 57 (15 to 144) | 24 (15 to 135) |
Collected over Medication side effects were measured using a 28-item side effect checklist rating scale at week 1 (1 week before starting medication), week 3 (target quit day) through 14, and week 27.. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Placebo - Week 1 | 0/136 (0%) | 28/136 (20.6%) | 104/136 (76.5%) |
| Varenicline - Week 1 | 0/164 (0%) | 34/164 (20.7%) | 136/164 (82.9%) |
| Placebo - Week 3 | 0/114 (0%) | 24/114 (21.1%) | 90/114 (78.9%) |
| Varenicline - Week 3 | 0/137 (0%) | 29/137 (21.2%) | 103/137 (75.2%) |
| Placebo - Week 4 | 0/100 (0%) | 21/100 (21%) | 80/100 (80%) |
| Varenicline - Week 4 | 0/120 (0%) | 19/120 (15.8%) | 93/120 (77.5%) |
| Placebo - Week 6 | 0/91 (0%) | 26/91 (28.6%) | 68/91 (74.7%) |
| Varenicline - Week 6 | 0/121 (0%) | 22/121 (18.2%) | 81/121 (66.9%) |
| Placebo - Week 7 | 0/85 (0%) | 18/85 (21.2%) | 65/85 (76.5%) |
| Varenicline - Week 7 | 0/119 (0%) | 18/119 (15.1%) | 77/119 (64.7%) |
| Placebo - Week 8 | 0/80 (0%) | 15/80 (18.8%) | 57/80 (71.3%) |
| Varenicline - Week 8 | 0/115 (0%) | 14/115 (12.2%) | 71/115 (61.7%) |
| Placebo - Week 10 | 0/79 (0%) | 15/79 (19%) | 51/79 (64.6%) |
| Varenicline - Week 10 | 0/113 (0%) | 18/113 (15.9%) | 71/113 (62.8%) |
| Placebo - Week 12 | 0/79 (0%) | 12/79 (15.2%) | 52/79 (65.8%) |
| Varenicline - Week 12 | 0/109 (0%) | 12/109 (11%) | 63/109 (57.8%) |
| Placebo - Week 14 | 0/74 (0%) | 9/74 (12.2%) | 50/74 (67.6%) |
| Varenicline - Week 14 | 0/104 (0%) | 8/104 (7.7%) | 60/104 (57.7%) |
| Placebo - Week 27 | 0/68 (0%) | 10/68 (14.7%) | 37/68 (54.4%) |
| Varenicline - Week 27 | 0/102 (0%) | 12/102 (11.8%) | 55/102 (53.9%) |
| Event | Placebo - Week 1 | Varenicline - Week 1 | Placebo - Week 3 | Varenicline - Week 3 | Placebo - Week 4 | Varenicline - Week 4 | Placebo - Week 6 | Varenicline - Week 6 | Placebo - Week 7 | Varenicline - Week 7 | Placebo - Week 8 | Varenicline - Week 8 | Placebo - Week 10 | Varenicline - Week 10 | Placebo - Week 12 | Varenicline - Week 12 | Placebo - Week 14 | Varenicline - Week 14 | Placebo - Week 27 | Varenicline - Week 27 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AgitationPsychiatric disorders | 20/136 | 19/164 | 10/114 | 16/137 | 12/100 | 10/120 | 12/91 | 9/121 | 10/85 | 11/119 | 7/80 | 10/115 | 8/79 | 10/113 | 9/79 | 7/109 | 5/74 | 7/104 | 8/68 | 4/102 |
| Suicidal thoughts or i deationPsychiatric disorders | 4/136 | 15/164 | 6/114 | 8/137 | 3/100 | 6/120 | 9/91 | 6/121 | 5/85 | 7/119 | 5/80 | 4/115 | 3/79 | 5/113 | 3/79 | 2/109 | 3/74 | 1/104 | 1/68 | 5/102 |
| HostilityPsychiatric disorders | 6/136 | 8/164 | 5/114 | 2/137 | 8/100 | 4/120 | 4/91 | 5/121 | 6/85 | 4/119 | 7/80 | 3/115 | 5/79 | 5/113 | 4/79 | 5/109 | 4/74 | 3/104 | 1/68 | 3/102 |
| IrritabilityPsychiatric disorders | 4/136 | 1/164 | 3/114 | 3/137 | 4/100 | 3/120 | 5/91 | 4/121 | 3/85 | 3/119 | 2/80 | 1/115 | 2/79 | 5/113 | 1/79 | 1/109 | 2/74 | 2/104 | 2/68 | 1/102 |
| Depressed MoodPsychiatric disorders | 3/136 | 3/164 | 3/114 | 4/137 | 2/100 | 4/120 | 1/91 | 6/121 | 1/85 | 4/119 | 4/80 | 4/115 | 0/79 | 2/113 | 0/79 | 4/109 | 1/74 | 2/104 | 0/68 | 0/102 |
| AnxietyPsychiatric disorders | 5/136 | 3/164 | 1/114 | 3/137 | 1/100 | 4/120 | 2/91 | 5/121 | 1/85 | 3/119 | 2/80 | 1/115 | 3/79 | 3/113 | 3/79 | 2/109 | 0/74 | 1/104 | 1/68 | 1/102 |
| Weakness on one or both sides of the bodyGeneral disorders | 1/136 | 1/164 | 0/114 | 1/137 | 3/100 | 0/120 | 2/91 | 2/121 | 1/85 | 0/119 | 0/80 | 1/115 | 0/79 | 1/113 | 0/79 | 0/109 | 1/74 | 0/104 | 0/68 | 1/102 |
| NauseaGeneral disorders | 0/136 | 1/164 | 2/114 | 3/137 | 0/100 | 0/120 | 2/91 | 1/121 | 0/85 | 2/119 | 0/80 | 0/115 | 1/79 | 3/113 | 1/79 | 0/109 | 0/74 | 0/104 | 1/68 | 1/102 |
| Abdominal PainGastrointestinal disorders | 0/136 | 0/164 | 2/114 | 2/137 | 1/100 | 0/120 | 1/91 | 0/121 | 0/85 | 1/119 | 0/80 | 0/115 | 0/79 | 3/113 | 0/79 | 1/109 | 0/74 | 1/104 | 0/68 | 0/102 |
| HeadacheGeneral disorders | 1/136 | 3/164 | 2/114 | 1/137 | 0/100 | 1/120 | 1/91 | 3/121 | 0/85 | 2/119 | 1/80 | 1/115 | 0/79 | 2/113 | 1/79 | 2/109 | 1/74 | 2/104 | 0/68 | 1/102 |
| Event | Placebo - Week 1 | Varenicline - Week 1 | Placebo - Week 3 | Varenicline - Week 3 | Placebo - Week 4 | Varenicline - Week 4 | Placebo - Week 6 | Varenicline - Week 6 | Placebo - Week 7 | Varenicline - Week 7 | Placebo - Week 8 | Varenicline - Week 8 | Placebo - Week 10 | Varenicline - Week 10 | Placebo - Week 12 | Varenicline - Week 12 | Placebo - Week 14 | Varenicline - Week 14 | Placebo - Week 27 | Varenicline - Week 27 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AnxietyPsychiatric disorders | 67/136 | 76/164 | 57/114 | 55/137 | 50/100 | 43/120 | 42/91 | 42/121 | 39/85 | 42/119 | 41/80 | 39/115 | 33/79 | 31/113 | 30/79 | 33/109 | 32/74 | 27/104 | 25/68 | 30/102 |
| Sleep problemsPsychiatric disorders | 36/136 | 61/164 | 23/114 | 32/137 | 16/100 | 23/120 | 20/91 | 13/121 | 14/85 | 21/119 | 17/80 | 22/115 | 8/79 | 14/113 | 8/79 | 13/109 | 7/74 | 13/104 | 8/68 | 10/102 |
| AgitationPsychiatric disorders | 33/136 | 44/164 | 29/114 | 30/137 | 31/100 | 34/120 | 23/91 | 29/121 | 20/85 | 28/119 | 21/80 | 20/115 | 24/79 | 17/113 | 20/79 | 19/109 | 21/74 | 17/104 | 14/68 | 20/102 |
| Depressed MoodPsychiatric disorders | 37/136 | 41/164 | 15/114 | 21/137 | 19/100 | 16/120 | 9/91 | 14/121 | 13/85 | 17/119 | 8/80 | 16/115 | 15/79 | 15/113 | 10/79 | 6/109 | 7/74 | 7/104 | 9/68 | 15/102 |
| Fatigue/lethargyGeneral disorders | 36/136 | 41/164 | 20/114 | 20/137 | 18/100 | 23/120 | 15/91 | 18/121 | 15/85 | 13/119 | 7/80 | 17/115 | 12/79 | 13/113 | 7/79 | 12/109 | 9/74 | 11/104 | 6/68 | 10/102 |
| Abdominal PainGastrointestinal disorders | 21/136 | 23/164 | 13/114 | 28/137 | 14/100 | 28/120 | 15/91 | 24/121 | 14/85 | 21/119 | 12/80 | 21/115 | 12/79 | 21/113 | 15/79 | 15/109 | 13/74 | 11/104 | 8/68 | 17/102 |
| InsomniaPsychiatric disorders | 21/136 | 37/164 | 12/114 | 20/137 | 12/100 | 10/120 | 10/91 | 14/121 | 12/85 | 11/119 | 8/80 | 12/115 | 7/79 | 8/113 | 10/79 | 5/109 | 7/74 | 7/104 | 8/68 | 8/102 |
| IrritabilityPsychiatric disorders | 16/136 | 30/164 | 11/114 | 14/137 | 12/100 | 15/120 | 8/91 | 16/121 | 11/85 | 10/119 | 12/80 | 14/115 | 11/79 | 10/113 | 6/79 | 8/109 | 7/74 | 6/104 | 3/68 | 7/102 |
| HostilityPsychiatric disorders | 17/136 | 21/164 | 14/114 | 11/137 | 12/100 | 14/120 | 5/91 | 12/121 | 9/85 | 18/119 | 8/80 | 13/115 | 14/79 | 11/113 | 10/79 | 11/109 | 9/74 | 9/104 | 10/68 | 8/102 |
| Weakness on one or both sides of the bodyGeneral disorders | 21/136 | 23/164 | 18/114 | 14/137 | 9/100 | 10/120 | 7/91 | 9/121 | 9/85 | 15/119 | 6/80 | 10/115 | 7/79 | 11/113 | 6/79 | 13/109 | 10/74 | 10/104 | 5/68 | 9/102 |
| Age, Categorical(Participants) | Standard Treatment + Placebo Varenicline | BASC + Placebo Varenicline | Standard Treatment + Active Varenicline | BASC + Active Varenicline | Total |
|---|---|---|---|---|---|
| <=18 years | 0 | 0 | 0 | 0 | 0 |
| Between 18 and 65 years | 63 | 58 | 74 | 75 | 270 |
| >=65 years | 5 | 10 | 7 | 8 | 30 |
| Age, Continuous(years) | Standard Treatment + Placebo Varenicline | BASC + Placebo Varenicline | Standard Treatment + Active Varenicline | BASC + Active Varenicline | Total |
|---|---|---|---|---|---|
| Mean | 50.3 ± 10.8 | 50.7 ± 13.5 | 48.7 ± 12.7 | 50.3 ± 13.2 | 50.0 ± 12.6 |
| Sex: Female, Male(Participants) | Standard Treatment + Placebo Varenicline | BASC + Placebo Varenicline | Standard Treatment + Active Varenicline | BASC + Active Varenicline | Total |
|---|---|---|---|---|---|
| Female | 39 | 38 | 44 | 44 | 165 |
| Male | 29 | 30 | 37 | 39 | 135 |
| Race (NIH/OMB)(Participants) | Standard Treatment + Placebo Varenicline | BASC + Placebo Varenicline | Standard Treatment + Active Varenicline | BASC + Active Varenicline | Total |
|---|---|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 1 | 1 | 2 |
| Asian | 0 | 1 | 3 | 0 | 4 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 | 0 | 0 |
| Black or African American | 40 | 37 | 43 | 37 | 157 |
| White | 25 | 27 | 28 | 36 | 116 |
| More than one race | 1 | 3 | 4 | 8 | 16 |
| Unknown or Not Reported | 2 | 0 | 2 | 1 | 5 |
| Region of Enrollment(participants) | Standard Treatment + Placebo Varenicline | BASC + Placebo Varenicline | Standard Treatment + Active Varenicline | BASC + Active Varenicline | Total |
|---|---|---|---|---|---|
| United States | 68 | 68 | 81 | 83 | 300 |
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Northwestern University