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Smoking CessationPhase 4NCT01807871

Treatment of Smoking Lapses and Relapses

A Phase 4 study testing nicotine patch, experimental use and nicotine patch, labeled use in people with Smoking Cessation, run by University of Vermont at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Many smokers who try to stop smoking with nicotine medications (NM) such as gum, lozenge and patch, go back to smoking (i.e., a slip or lapse). Currently, labeling on many NM products tells smokers who lapse while using NM to stop NM. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Smoking Cessation
What is being tested?
nicotine patch, experimental use and nicotine patch, labeled use
Could I receive a placebo?
No, everyone receives an active treatment
How many people
701 participants
Where
1 siteUnited States
Study dates
Mar 2013to Feb 2016
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • at least 18 years old
  • daily smoker of 10 or more cigarettes per day for at least 1 year
  • state they plan to probably or definitely quit smoking in the next month
  • have a home or cell phone
  • willing to use nicotine patch
  • good command of written and spoken English
  • weigh at least 100 pounds
  • US citizen or permanent resident alien

Who cannot join

  • use of non-cigarette tobacco in the last month
  • use of a smoking cessation medication or smoking cessation counseling in the last month
  • medical contraindication to use of patch
  • other person in household already in our study
  • previously a participant in the study
  • currently pregnant or breast feeding
Show all 9Show fewer
  • plan to become pregnant in the next 6 months
  • regularly works the overnight shift
  • use of electronic cigarettes in the last month

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Vermont

    Burlington, Vermont, 05401

Other trials in United States

About this study

Many smokers who try to stop smoking with nicotine medications (NM) such as gum, lozenge and patch, go back to smoking (i.e., a slip or lapse). Currently, labeling on many NM products tells smokers who lapse while using NM to stop NM. However, some studies suggest it is safe to continue NM upon a lapse and that doing so dramatically increases success at quitting. The investigators will test this by doing a randomized trial in which all treatment and measures are done from home with paper, phone or computer surveys. The investigators will recruit smokers who want to quit, provide them with 10 weeks of nicotine patch treatment and 5 weeks of counseling. One group will be asked to stop use of the patch if they lapse and the other group will be asked to continue use of the patch if they lapse. The investigators will compare the groups on their success at quitting and side-effects.

Read the detailed description

Objectives:

To test our hypothesis that among the subset of the 770 enrolled participants who quit smoking and then lapsed while using the nicotine patch, those randomized to continue the patch post-lapse will be more likely to be 7-day point prevalent abstinent at 4-month follow-up than those randomized to discontinue the patch post-lapse.

To test whether the amount of patch use post-lapse, craving, withdrawal, cigs/day, motivation to quit, confidence in quitting, nicotine reinforcement from cigarettes, and self-efficacy mediate any effect of post-lapse patch use on abstinence.

To test whether the incidence of adverse events (AEs) during post-lapse patch use is minimal.

Purpose:

Over the counter (OTC) NRT is, by far, the most common treatment for smoking cessation in the United States (Cokkinides, Ward, Jemel, \& Thun, 2005). Over 80% of those using OTC NRT will lapse (Stead, Perera, Bullen, Mant, \& Lancaster, 2008). One possible reason for this high rate of relapse is that NRT package labeling states "do not use if you continue to smoke", and the majority of smokers believe this means it is best to stop using NRT upon a lapse; e.g., the only survey on real-world use of NRT during a lapse episode found that 77% of smokers discontinued NRT after a lapse (Pierce \& Gilpin, 2002). The investigators and others (Bader, McDonald, \& Selby, 2009) believe continuing NRT during a lapse episode will a) relieve craving and withdrawal (West \& Shiffman, 2001), b) block the reinforcing effects of smoking (Perkins, Fonte, Meeker, White, \& Wilson, 2001; Rose \& Behm, 2004), c) help smokers smoke less (Hughes \& Carpenter, 2005), and d) increase self-efficacy, all of which should help smokers re-establish abstinence.

Study design:

The investigators are proposing a parallel groups randomized controlled trial (RCT) in which all treatment and monitoring occur via phone, and medication via mail. The investigators will recruit about 770 smokers to receive phone counseling before and after the quit date and nicotine patches for 10 weeks after the quit date. At study entry, smokers will be randomized to a "Continue NRT" or a "Discontinue NRT" condition. The Continue NRT participants will be advised that, if they lapse, they should continue NRT. Smokers randomized to the Discontinue NRT condition will be advised that, if they lapse, they should discontinue NRT use. The messages will also include rationales. Messages will be delivered several times via written material, Interactive Voice Response (IVR) messages and during phone counseling. Participants will record cigs/day nightly via a phone-based IVR system for 10 weeks. If the IVR detects a lapse during the first 10 weeks of the study, it will encourage the participant to re-establish abstinence as soon as possible and repeat the condition-appropriate message about post-lapse NRT use. After the 10-week treatment period, the investigators will use monthly questionnaires (online or paper) to assess recent smoking, cigs/day, NRT use, and other stop-smoking medications.

Subject selection:

Men and women, minorities and children over 18 will be included. Pregnant and breastfeeding women, women who plan to become pregnant and those at risk for AEs from NRT will be excluded. Our goal is to recruit a sample of the same gender, ethnicity/race prevalence as that of US smokers interested in quitting; i.e. 52% men, 78% White/Non-Hispanic, 11% Black, 8% Hispanic and 3% other ethnicities/races (Hughes \& Callas, 2010). The investigators do not have data on which to estimate the percent who will be children between ages 18-21 but most studies suggest very few young smokers are interested in formal treatment (Sussman, 2002).

Number of subjects:

The investigators have chosen an initial inclusion of 770 smokers to obtain a sample size of 490 smokers who lapse on NRT.

Being tested
nicotine patch, experimental use, nicotine patch, labeled use
Keywords
nicotine dependence, smoking cessation, lapse, relapse, tobacco, nicotine patch, nicotine replacement therapy, NRT
Medical subject headings
Smoking Cessation, Tobacco Use Disorder, Recurrence

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • nicotine patch, experimental useDrug

    Also called Nicoderm Clear 21 mg, Nicoderm Clear 14 mg, Nicoderm Clear 7 mg

    nicotine patch-transdermal, continue during lapses Nicotine patches are used according to normal package label, except if the participant lapses and smokes, they will continue to use the patch.

  • nicotine patch, labeled useDrug

    Also called Nicoderm Clear 21 mg, Nicoderm Clear 14 mg, Nicoderm Clear 7 mg

    nicotine patch-transdermal, discontinue during lapses Participants will use the nicotine patch while abstinent, but will remove the patch if there is a lapse and smoking resumes. This is the use indicated on current FDA approved labeling.

Study groups in NCT01807871
Study groupRoleWhat they receive
nicotine patch, experimental useExperimentalParticipants will continue to use nicotine patch after they lapse and resume smoking as long as smoking is less than 75% of pre study levels.
Receives: Drug: nicotine patch, experimental use
nicotine patch, labeled useActive comparatorParticipants will discontinue using the nicotine patch when they resume smoking. This is the current FDA approved use of the nicotine patches.
Receives: Drug: nicotine patch, labeled use

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Point-prevalent Abstinence at 4 Months

    To test our hypothesis that among the subset of the 701 enrolled participants who quit smoking and then lapsed while using the nicotine patch, those randomized to continue the patch post-lapse will be more likely to be 7-day point-prevalent abstinent at 4 month follow-up than those randomized to discontinue the patch post-lapse. 7-day point prevalent abstinence was assessed by response to the question "In the last 7 days, on how many days did you smoke" on the 4 month follow-up survey. Respondents who replied "0" were classified as "Yes" for 7-day point-prevalent abstinence; all other responses (including missing) were classified as "No".

    Measured: 4 months after the quit date

Secondary outcomes (2)
  1. Mediators of Effect of Post-lapse Nicotine Replacement Therapy Use on Abstinence

    To test whether the amount of use of nicotine patch post-lapse, craving, withdrawal, cigs/day, motivation to quit, confidence in quitting, nicotine reinforcement from cigarettes, and self-efficacy mediate any effect of post-lapse patch use on abstinence.

    Measured: 4 months after the quit date

  2. Adverse Drug Effects

    To test whether the incidence of adverse drug effects during the post-lapse use of nicotine patch is minimal.

    Measured: Up to 12 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Mar 2013 (estimated)
  2. Study startMar 2013
  3. Primary completionFeb 2016
  4. Study completionFeb 2016

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
701 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01807871
Sponsor's protocol ID
M12-113
Other IDs
R01CA165080
Status last verified
Sep 2017
First submitted
4 Mar 2013
Last updated
13 Oct 2017
Data monitoring committee
No
Individual data sharing
No

Publications

  • Cokkinides VE, Ward E, Jemal A, Thun MJ. Under-use of smoking-cessation treatments: results from the National Health Interview Survey, 2000. Am J Prev Med. 2005 Jan;28(1):119-22. doi: 10.1016/j.amepre.2004.09.007.

    PubMed 15626567
  • Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD000146. doi: 10.1002/14651858.CD000146.pub3.

    PubMed 18253970
  • Pierce JP, Gilpin EA. Impact of over-the-counter sales on effectiveness of pharmaceutical aids for smoking cessation. JAMA. 2002 Sep 11;288(10):1260-4. doi: 10.1001/jama.288.10.1260.

    PubMed 12215133
  • Bader P, McDonald P, Selby P. An algorithm for tailoring pharmacotherapy for smoking cessation: results from a Delphi panel of international experts. Tob Control. 2009 Feb;18(1):34-42. doi: 10.1136/tc.2008.025635. Epub 2008 Oct 9.

    PubMed 18845621
  • West R, Shiffman S. Effect of oral nicotine dosing forms on cigarette withdrawal symptoms and craving: a systematic review. Psychopharmacology (Berl). 2001 May;155(2):115-22. doi: 10.1007/s002130100712.

    PubMed 11400998
  • Perkins KA, Fonte C, Meeker J, White W, Wilson A. The discriminative stimulus and reinforcing effects of nicotine in humans following nicotine pretreatment. Behav Pharmacol. 2001 Feb;12(1):35-44. doi: 10.1097/00008877-200102000-00004.

    PubMed 11270510
  • Hughes JR, Carpenter MJ. The feasibility of smoking reduction: an update. Addiction. 2005 Aug;100(8):1074-89. doi: 10.1111/j.1360-0443.2005.01174.x.

    PubMed 16042638
  • Sussman S. Effects of sixty six adolescent tobacco use cessation trials and seventeen prospective studies of self-initiated quitting. Tob Induc Dis. 2002 Jan 15;1(1):35-81. doi: 10.1186/1617-9625-1-1-35.

    PubMed 19570247
  • Hughes JR, Solomon LJ, Peasley-Miklus CE, Callas PW, Fingar JR. Effectiveness of continuing nicotine replacement after a lapse: A randomized trial. Addict Behav. 2018 Jan;76:68-81. doi: 10.1016/j.addbeh.2017.07.023. Epub 2017 Jul 14.

    PubMed 28756042
  • Theodoulou A, Chepkin SC, Ye W, Fanshawe TR, Bullen C, Hartmann-Boyce J, Livingstone-Banks J, Hajizadeh A, Lindson N. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2023 Jun 19;6(6):CD013308. doi: 10.1002/14651858.CD013308.pub2.

    PubMed 37335995

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing nicotine patch, experimental use and nicotine patch, labeled use in people with Smoking Cessation, run by University of Vermont at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 13 Oct 2017. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 28 Mar 2017). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Point-prevalent Abstinence at 4 Months (time frame: 4 months after the quit date). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01807871, which also lists 10 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Oct 2017.

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