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Addict Behav. 2017 Dec;75:122-129. doi: 10.1016/j.addbeh.2017.07.006. Epub 2017 Jul 12.

Measures and predictors of varenicline adherence in the treatment of nicotine dependence.

Author information

1
Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Cir, Toronto, ON M5S 1A8, Canada. Electronic address: a.peng@mail.utoronto.ca.
2
Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States. Electronic address: mark.morales@uphs.upenn.edu.
3
Department of Biostatistics & Epidemiology, University of Pennsylvania, 423 Guardian Dr, Philadelphia, PA 19104, United States. Electronic address: epw@mail.med.upenn.edu.
4
Department of Psychology, State University of New York at Buffalo, 230 Park Hall, Buffalo, NY 14260-4110, United States. Electronic address: lhawk@buffalo.edu.
5
Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler St, Houston, TX 77030, United States. Electronic address: pcinciri@mdanderson.org.
6
Addictions Division, Centre for Addiction and Mental Health and Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada. Electronic address: Tony.George@camh.ca.
7
Department of Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, United States; Department of Bioengineering & Therapeutic Sciences, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, United States. Electronic address: neal.benowitz@ucsf.edu.
8
Department of Preventive Medicine & Public Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66160, United States. Electronic address: NNOLLEN@kumc.edu.
9
Department of Psychiatry, Annenberg School for Communication, Abramson Cancer Center, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, United States. Electronic address: CLerman@mail.med.upenn.edu.
10
Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Cir, Toronto, ON M5S 1A8, Canada; Addictions Division, Centre for Addiction and Mental Health and Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada. Electronic address: r.tyndale@utoronto.ca.
11
Department of Psychiatry, Abramson Cancer Center, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, United States. Electronic address: schnoll@mail.med.upenn.edu.

Abstract

INTRODUCTION:

While adherence to medication in smoking cessation clinical trials is strongly associated with clinical outcome, very few studies have evaluated the validity of pill count as a measure of adherence relative to a biological assay, and evaluated a broad range of correlates of adherence.

METHODS:

In a smoking cessation clinical trial of varenicline, we compared pill counts collected over 4 different time periods to varenicline salivary levels taken after 2weeks of treatment, as well as evaluated predictors of adherence to varenicline.

RESULTS:

Using a binary measure of adherence based on salivary varenicline levels, adherence was higher among older, white, and more educated participants. Relative to 3, 7, and 14-day pill count, 12-week pill count was the only significant measure able to discriminate adherence as defined by salivary varenicline levels (assessed by area under the receiver operating characteristic curve; AUC=0.59, p=0.004). Seventy-two percent of participants who indicated adherence on 12-week pill count were classified as adherent based on varenicline saliva levels (sensitivity=0.80; specificity=0.40). There was modest variability in the relationship between 12-week pill count and varenicline levels across race and rate of nicotine metabolism. Lastly, General Estimating Equation models demonstrated that longitudinal changes in withdrawal, craving, negative and positive affect, and side effect count and severity were not related to adherence based on salivary varenicline levels.

CONCLUSIONS:

These results indicate that 12-week pill count was the best, albeit a relatively weak, measure of varenicline adherence; additional factors associated with treatment adherence need to be identified.

KEYWORDS:

Adherence; Nicotine dependence; Smoking cessation; Varenicline

PMID:
28728040
PMCID:
PMC5581992
[Available on 2018-12-01]
DOI:
10.1016/j.addbeh.2017.07.006
[Indexed for MEDLINE]

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