That Patient Who Will Not Quit – A New Treatment Option

April 18, 2007

Michael C. Fiore, MD, MPHProfessor of MedicineDirector, Center for Tobacco Research and InterventionUniversity of Wisconsin School of Medicine and Public Health

Over the last year, I have served as an investigator in research studies at the University of Wisconsin that were funded by Pfizer. In 1998, I was appointed to a named Chair made possible by an unrestricted gift to UW from GlaxoWellcome to the University of Wisconsin.

Disclosure Statement

Case Study

Mr. and Mrs. S

• Both late 60s

• Both NIDDM

• Both Hyperlipidemia

• Both BMIs over 35

• Both smoke more than a ppd and have tried to quit many times

A New Quit Attempt

Varenicline Quit Line

Varenicline

Approved by FDA in May, 2006 Marketed as Chantix A non-nicotine medication A selective 42 Nicotinic

Acetylcholine Receptor Partial Agonist

Varenicline: A Highly Selective 42 Receptor Partial Agonist

Chantix

Chantix is an 42 nicotinic receptor partial agonist, a compound with dual agonist and antagonist activities. This is believed to result in both a lesser amount of dopamine release from the VTA at the nAcc as well as the prevention of nicotine binding at the 42 receptors

Nicotine

Binding of nicotine at the 42 nicotinic receptor in the Ventral Tegmental Area (VTA) is believed to cause release of dopamine at the Nucleus Accumbens (nAcc)

Varenicline

Efficacy Data

Varenicline Phase 3 Studies: Efficacy Measurements: CO-Confirmed 4-Wk Continuous Abstinence Rates Wks 9-12

Point Prevalence Outcome

Varenicline: Most Common Adverse EventsFrom 12-Week Fixed-Dose, Placebo-Controlled Studies

Varenicline – Prescribing Information

Start varenicline one week before the quit date for maximum effectiveness

Recommended treatment is 12 weeks:– Days 1-3………..1 pill (0.5 mg) per day– Days 4-7………..1 pill (0.5 mg) twice a day (am & pm)– Day 8-end………1 pill (1 mg) twice a day (am & pm)

An additional course of 12 weeks for maintenance can be considered

Treatment

Counseling

– The Wisconsin Tobacco Quit Line at 1-800-QUIT-NOW.

– It’s free, confidential, and non-judgmental. – Callers are 4 times more likely to quit than

those who try to quit cold turkey.– Services are available in virtually any language.

Designed to help employees at the University of Wisconsin Hospital and Clinics quit.

A UWHC Employee Program

608-438-4517

UW-CTRI Outreach Specialist

Southern Region-Madison

Tricia Brein, MS

UW-CTRI

1930 Monroe St, Suite 200

Madison, WI 53711

608-265-4860

Fax: 608-265-3102

trb@ctri.medicine.wisc.edu

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www.ctri.wisc.edu