Counseling inflating Chantix outcomes?

The Disease Care Management Blog offers a take on Chantix that I had not yet heard.

The Disease Management Care Blog was struck by Wall Street Journal Health Blog’s (WSJHB) coverage of another varenicline (Chantix) peer review publication. Reported in Thorax, study participants were randomly assigned to Chantix or to a nicotine patch. While early abstinence rates favored Chantix, the one year quit rates (26% vs. 20%) failed to achieve statistical difference (p=.056)….

The DMCB took some additional time to review some other publications on Chantix here, here and here. What was striking about these studies was that Chantix’s success was always accompanied by multiple follow-up 10 minute tobacco cessation office visits. [emphasis mine] The DMCB interprets this as showing that Chantix’s quit rates are intertwined with a significant degree of ongoing counseling. In fact, we really don’t know how well Chantix works without counseling. What’s more, tobacco cessation guidelines echo the necessity of prescribing tobacco cessation medications in conjunction with close follow-up:

‘There is a strong dose-response relationship between the intensity of tobacco dependence counseling and its effectiveness. Treatments involving person-to-person contact (ie, via individual, group, or proactive telephone counseling) are consistently effective, and their effectiveness increases with treatment intensity (eg, the number of minutes of contact). If the patient agrees to attempt cessation, the clinician should then assist in making a quit attempt and should arrange for follow-up contacts to prevent a relapse. The treatment of tobacco dependence, like the treatment of other chronic diseases, requires the use of multiple modalities. ‘