The authors concluded that both drugs gave rise to high rates of clinical remission although neither drug was superior .
References 1 Feagan BG et al . Ustekinumab as Induction and Maintenance Therapy for Crohn ’ s Disease . N Engl J Med 2016 ; 375 ( 20 ): 1946 – 60 . 2 Hanauer SB et al . Human anti-tumor necrosis factor monoclonal antibody ( adalimumab ) in Crohn ’ s disease : the CLASSIC-I trial . Gastroenterology 2006 ; 130 ( 2 ): 323 – 33 . 3 Singh S et al . Systematic review and network meta-analysis : first- and second-line biologic therapies for moderate-severe Crohn ’ s disease . Aliment Pharmacol Ther 2018 ; 48 ( 4 ): 394 – 409 . 4 Sands B et al . Ustekinumab versus adalimumab for induction and maintenance therapy in biologic-naive patients with moderately to severely active Crohn ’ s disease : a multicentre , randomised , double-blind , parallel-group , phase 3b trial . Lancet 2022 ; 399:2200 – 211 .
Varenicline proves effective for long-term smoking cessation in diabetic patients
Cigarette smoking has long been recognised as a risk factor for cardiovascular disease . However , smoking among diabetic patients is especially harmful because it can result in a greater degree of vascular damage , thereby increasing the risks of coronary heart disease , stroke and mortality . Nevertheless , despite the enhanced risk of harm , a 2019 systematic review identified that , globally , one in five patients with type 2 diabetes are smokers . 1 Moreover , other evidence has revealed how smoking cessation in type 2 diabetic patients , even where individuals experience some degree of weight gain , is still associated with mortality benefits . 2 While there is evidence to show that the use of varenicline is an effective intervention for smokers with cardiovascular disease and chronic obstructive pulmonary disease , less is known about the effectiveness in patients with type 2 diabetes .
Researchers undertook a randomised , prospective study of varenicline use in patients with type 2 diabetes and who wanted to stop smoking . 3 Individuals who had type 2 diabetes for at least 12 months , an HbA1c of between 7 and 12 % and who smoked 10 or more cigarettes every day were enrolled in the trial . Eligible patients were randomised 1:1 to receive varenicline 1mg twice daily for 12 weeks or matching placebo . After completion of the 12 weeks of therapy , a 6-week , non-drug follow-up phase began and the primary outcome measure for the trial was the continuous abstinence rate ( CAR ) at weeks 9 to 24 , which was defined in terms of an electronic carbon monoxide level of below 10ppm . Patients were followed up for a total of 52 weeks , during which time , smoking habits and exhaled carbon monoxide levels were assessed . In addition , patients in both arms of the trial received smoking cessation counselling .
A total of 300 patients with a mean age of 57.4 years ( 78 % male ) were randomised to varenicline or placebo .
The CARs at weeks 9 to 24 were significantly higher for patients assigned to varenicline compared to placebo ( odds ratio , OR = 4.95 , 95 % CI 2.29 – 10.70 , p < 0.01 ). In fact , the CARs between weeks 9 and 52 were also significantly greater for those assigned to treatment ( OR = 4.07 , 95 % CI 1.79 – 9.27 , p < 0.01 ).
The study also considered the level of adverse effects , noting that 70 % of those receiving varenicline , compared to 64 % in the placebo arm , experienced adverse events . Fortunately , however , most adverse events were reported as mild or moderate but only led to treatment discontinuation in 6 varenicline patients and 5 in the placebo arm .
Based on these results , the authors suggested that varenicline should be incorporated into smoking cessation programmes for patients with type 2 diabetes .
References 1 Roderick P et al . The global prevalence of tobacco use in type 2 diabetes mellitus patients : a systematic review and metaanalysis . Diabetes Res Clin Pract 2019 ; 154:52 – 65 2 Liu G et al . Smoking cessation and weight changes in relation to cardiovascular disease incidence and mortality in people with type 2 diabetes : a population-based cohort study . Lancet Diabetes Endrocrinol 2020 ; 8 ( 2 ): 125 – 33 . 3 Russo C et al . Efficacy and safety of varenicline for smoking cessation in patients with type 2 diabetes : a randomised clinical trial . JAMA Netw Open 2022 ; 5 ( 6 ): e2217709 .
36 | Issue 101 | hospitalpharmacyeurope . com