Nicotine DependencePhase 4NCT04188873
Cessation Screening Project
A Phase 4 study testing Preparation Varenicline and Standard Duration Varenicline, Preparation Varenicline and Extended Duration Varenicline and Standard Duration Varenicline in people with Nicotine Dependence, run by University of Wisconsin, Madison at 2 sites in United States.
Trial summary
This project will use the Multiphase Optimization Strategy (MOST) to guide the development of optimized treatment strategies for the two most effective smoking cessation medications (Combination Nicotine Replacement [C-NRT] and varenicline). Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Nicotine Dependence
- What is being tested?
- Preparation Varenicline and Standard Duration Varenicline, Preparation Varenicline and Extended Duration Varenicline and Standard Duration Varenicline
- Type of treatment
- Pill or oral medicine, Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 538 participants
- Where
- 2 sitesUnited States
- Study dates
- 10 Dec 2020to 8 May 2025
- 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
- Smoking >4 cigarettes/day for the previous 6 months
- Able to read, write, and speak English
- If currently using nicotine replacement therapy (NRT), agreeing to use only study medication for the duration of the study
- Medically eligible to use study medications
- If the participant is a woman of childbearing potential, using an approved method of birth control during treatment
Who cannot join
- Currently taking bupropion or varenicline
- Suicidal ideation in the last 12 months or any suicide attempts in the past 10 years
Trial locations and contacts
2 sites in 1 country.
United States2 sites
University of Wisconsin Center for Tobacco Research and Intervention
Madison, Wisconsin, 53711
UW Center for Tobacco Research and Intervention
Milwaukee, Wisconsin, 53233
About this study
Official title: Optimized Chronic Care for Smokers: Developing and Implementing Integrated Clinical and Systems Interventions in Primary Care - Cessation Trial
This project will use the Multiphase Optimization Strategy (MOST) to guide the development of optimized treatment strategies for the two most effective smoking cessation medications (Combination Nicotine Replacement [C-NRT] and varenicline). The investigators will recruit daily smokers from primary care to participate in a fully crossed, 2x2x2x2 factorial experiment (N=608) that evaluates 4 different factors: 1) Medication Type (Varenicline vs. C-NRT), 2) Preparation Medication (4 Weeks vs. Standard), 3) Medication Duration (Extended [24 weeks] vs. Standard [12 weeks]); and 4) Counseling (Intensive vs. Minimal). Participants will complete assessments one week pre-quit and then assessments of smoking status, treatment use, side effects, potential treatment mechanisms (e.g., withdrawal, self-efficacy) during the first week post-target quit date (TQD) and at Weeks 2, 4, 12, 20, 26, and 52 post-target quit date. These data will be used to examine the main and interactive effects of these four factors on various outcomes, with biochemically confirmed 12-month abstinence serving as the primary outcome. These data will also be used to determine which factors and combinations of factors are most effective with regard to 12-month biochemically confirmed abstinence and cost, thereby identifying optimized varenicline and C-NRT treatments, with each developed to yield especially great benefit. These optimized treatments will then be tested in the Optimized Care Project. The investigators will also examine the relative effects of each medication on particular outcomes (e.g., 12-month abstinence).
Read the detailed description
Design and Objective: The Cessation Screening Project is a 4-factor factorial screening experiment (i.e., 2x2x2x2 = 16 experimental conditions) designed to identify the most promising intervention components that are especially effective and cost-effective with regard to their main and interactive effects on 12-month biochemically verified abstinence. This design will allow us to: 1) detect main effects and interactions within the factorial experiment and identify especially effective regimens for varenicline and for (Combination Nicotine Replacement) C-NRT; 2) compare the relative effectiveness of varenicline and C-NRT; and 3) identify the most effective and cost-effective counseling intensity to use with the optimized medication regimens. Finally, these results will allow us to identify two optimized treatment packages for use with primary care smokers interested in quitting: packages that include both counseling and pharmacotherapies optimized on the bases of effectiveness and cost.
Recruitment and Participants: Participants (N=608) will be primary care patients from 12 primary care clinics in two Wisconsin healthcare systems. Smokers will be identified via the healthcare system electronic health record (EHR). All EHR-identified smokers in a clinic will receive a mailed invitation to find out more about smoking treatment by calling a healthcare system Care Manager (CM). In addition, using an opt-out strategy, Medical Assistants (MAs), using an EHR-guided prompt, will inform all identified smokers seen at in-person or tele-health visits that they will be contacted by the CM unless the participant indicates s/he wants to opt-out. The participant contact information will then be automatically sent to the CM unless the participant opts out; the investigators have developed and used this workflow successfully in their past research. The CM will call and tell patients about the smoking cessation options available for them including the availability of this smoking cessation study. If patients are interested, the CM will obtain oral assent for screening and sharing contact, primary care team, and screening data with the research team before screening patients for eligibility. Eligible patients will learn more about the study and have a chance to ask questions and provide verbal informed consent. Finally, participants will complete a brief series of questions and then the CM will schedule a call with the study staff (i.e., a Health Counselor) in the database to initiate treatment and complete study assessments. Participants interested in quitting but not eligible for this study will be electronically referred to the Wisconsin Tobacco Quit Line and/or their primary care provider (PCP) by the CM.
Those who agree to and pass the screening for the inclusion/exclusion criteria for study participation will be asked to complete an oral consent and HIPAA authorization process next. After the patient provides oral consent, the CM will notify the patient's PCP via EHR that the patient has volunteered for a study with C-NRT or varenicline. The PCP will notify the CM via the EHR that the patient is medically eligible to receive either agent, as required by the collaborating healthcare systems. This will occur within 5 business days. The PCP will be notified via EHR of the patient's treatment assignment and of study-related serious adverse events or adverse events that prompt medication discontinuation that may occur. Care coordination with the PCP will occur via Tobacco Care Manager entry of data in the patient EHR.
Procedures and Measures: At the second study call, participants (N=608) will be randomized to one level of each of 4 factors: 1) Medication Type (Varenicline vs. C-NRT), 2) Preparation Medication (4 weeks vs. Standard), 3) Medication Duration (Extended vs. Standard), and 4) Counseling (Intensive vs. Minimal). Participants will be told their treatment condition at Call 2, set a target quit date (TQD), and instructed how to use their study medications. Medications will be mailed following this call, along with a handout that describes: 1) when to begin taking study medication; 2) the type and doses involved; 3) how and when to obtain the next month's medication; and 4) complete instructions on proper medication use, including information from the package insert and contact information if they have questions regarding their medication and/or symptoms they experience. Participants will be mailed all Preparation Medication as well as one month of post-quit study medication after Call 2. They will need to call in to a study line to request that more medication be mailed to them (Standard Duration participants will call one time to receive their final 2 months of medication; Extended Duration participants will call once to get 2 additional months of medication and again to get the remaining 3 months of study medication). Participants will also receive a counseling handout with their medications; those randomized to intensive counseling will receive a Quit Plan listing their target quit day and when they start the medications and those randomized to minimal counseling will receive the mobile health (mHealth) handout.
Participants will complete phone assessments one week pre-quit, during the first week post-target quit date (TQD) and at Weeks 2, 4, 12, 20, 26, and 52 post-TQD.
Outcomes: The primary outcome for this study is biochemically confirmed, point-prevalence abstinence at 12 months post-TQD (Primary Aim 1). The secondary outcome is cost effectiveness in which the costs of implementing each intervention (minus research-related costs) will be computed from a payer perspective. Costs will be combined with the intent-to-treat biochemically verified 7-day point prevalence abstinence at 12 months post-TQD to determine the cost per quit.
- Conditions
- Nicotine Dependence
- Being tested
- Preparation Varenicline and Standard Duration Varenicline, Preparation Varenicline and Extended Duration Varenicline, Standard Duration Varenicline, Extended Duration Varenicline, Preparation Combination NRT and Standard Duration Combination NRT
- Medical subject headings
- Tobacco Use Disorder
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Preparation Varenicline and Standard Duration VareniclineDrug
16 weeks of varenicline starting 4 weeks pre-quit
Preparation Varenicline and Extended Duration VareniclineDrug
28 weeks of varenicline starting 4 weeks pre-quit
Standard Duration VareniclineDrug
12 weeks of varenicline
Extended Duration VareniclineDrug
24 weeks of varenicline
Preparation Combination NRT and Standard Duration Combination NRTDrug
16 weeks of nicotine patch + nicotine mini-lozenge starting 4 weeks pre-quit
Preparation Combination NRT and Extended Duration Combination NRTDrug
28 weeks of nicotine patch + nicotine mini-lozenge starting 4 weeks pre-quit
Standard Duration Combination NRTDrug
12 weeks of nicotine patch + nicotine mini-lozenge
Extended Duration Combination NRTDrug
24 weeks of nicotine patch + nicotine mini-lozenge
Intensive CounselingBehavioural
4 phone or video counseling sessions
Minimal CounselingBehavioural
2 brief phone or video counseling sessions
| Study group | Role | What they receive |
|---|---|---|
| 12-week Varenicline with Minimal Counseling | Active comparator | Participants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 1 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily until 11 weeks post-TQD. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt. Receives: Drug: Standard Duration Varenicline; Behavioral: Minimal Counseling |
| 12-week Varenicline with 4-Week Preparation Varenicline and Minimal Counseling | Active comparator | Participants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 4 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily for the next 3 weeks pre-TQD and until 12 weeks post-TQD. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt. Receives: Drug: Preparation Varenicline and Standard Duration Varenicline; Behavioral: Minimal Counseling |
| 24-week Varenicline with Minimal Counseling | Active comparator | Participants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 1 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily until 23 weeks post-TQD. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt. Receives: Drug: Extended Duration Varenicline; Behavioral: Minimal Counseling |
| 24-week Varenicline with 4-Week Preparation Varenicline and Minimal Counseling | Active comparator | Participants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 4 weeks prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily for the next 3 weeks pre-TQD and until 24 weeks post-TQD. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt. Receives: Drug: Preparation Varenicline and Extended Duration Varenicline; Behavioral: Minimal Counseling |
| 12-week Varenicline with Intensive Counseling | Active comparator | Participants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 1 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily until 11 weeks post-TQD. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline. Receives: Drug: Standard Duration Varenicline; Behavioral: Intensive Counseling |
| 12-week Varenicline with 4-Week Preparation Varenicline and Intensive Counseling | Active comparator | Participants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 4 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily for the next 3 weeks pre-TQD and until 11 weeks post-TQD. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline. Receives: Drug: Preparation Varenicline and Standard Duration Varenicline; Behavioral: Intensive Counseling |
| 24-week Varenicline with Intensive Counseling | Active comparator | Participants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 1 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily until 23 weeks post-TQD. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline. Receives: Drug: Extended Duration Varenicline; Behavioral: Intensive Counseling |
| 24-week Varenicline with 4-Week Preparation Varenicline and Intensive Counseling | Active comparator | Participants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 4 weeks prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily for the next 3 weeks pre-TQD and until 24 weeks post-TQD. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline. Receives: Drug: Preparation Varenicline and Extended Duration Varenicline; Behavioral: Intensive Counseling |
| 12-week C-NRT with Minimal Counseling | Active comparator | Participants randomized to this intervention will receive 12 weeks of nicotine patches and nicotine mini-lozenges to use starting on their quit day. Participants who smoke more than 10 cigarettes/day will start with a 21 mg patch for 8 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 10 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt. Receives: Drug: Standard Duration Combination NRT; Behavioral: Minimal Counseling |
| 12-week C-NRT with 4-Week Preparation C-NRT and Minimal Counseling | Active comparator | Participants randomized to this intervention will receive 14 mg patches starting 4 weeks prior to the target quit day (TQD). Then, starting on the TQD, participants will receive 12 weeks of nicotine patches and nicotine mini-lozenges. Participants who smoke >10 cigarettes/day will start with a 21 mg patch for 8 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 10 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants will receive a brief 15-30 minute phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt. Receives: Drug: Preparation Combination NRT and Standard Duration Combination NRT; Behavioral: Minimal Counseling |
| 24-week C-NRT with Minimal Counseling | Active comparator | Participants randomized to this intervention will receive 24 weeks of nicotine patches and nicotine mini-lozenges, starting on the target quit day (TQD). Participants who smoke more than 10 cigarettes/day will start with a 21 mg patch for 20 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 22 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt. Receives: Drug: Extended Duration Combination NRT; Behavioral: Minimal Counseling |
| 24-week C-NRT with 4-Week Preparation C-NRT and Minimal Counseling | Active comparator | Participants randomized to this intervention will receive 14 mg patches starting 4 weeks prior to the target quit day (TQD). Then, starting on the TQD, participants will receive 24 weeks of nicotine patches and nicotine mini-lozenges. Participants who smoke more than 10 cigarettes/day will start with a 21 mg patch for 20 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 22 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt. Receives: Drug: Preparation Combination NRT and Extended Duration Combination NRT; Behavioral: Minimal Counseling |
| 12-week C-NRT with Intensive Counseling | Active comparator | Participants randomized to this intervention will receive 12 weeks of nicotine patches and nicotine mini-lozenges to use starting on their quit day. Participants who smoke more than 10 cigarettes/day will start with a 21 mg patch for 8 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 10 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline. Receives: Drug: Standard Duration Combination NRT; Behavioral: Intensive Counseling |
| 12-week C-NRT with 4-Week Preparation C-NRT and Intensive Counseling | Active comparator | Participants randomized to this intervention will receive 14 mg patches starting 4 weeks prior to the target quit day (TQD). Starting on the TQD, participants will receive 12 weeks of nicotine patches and nicotine mini-lozenges. Participants who smoke >10 cigarettes/day will start with a 21 mg patch for 8 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 10 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline. Receives: Drug: Preparation Combination NRT and Standard Duration Combination NRT; Behavioral: Intensive Counseling |
| 24-week C-NRT with Intensive Counseling | Active comparator | Participants randomized to this intervention will receive 24 weeks of nicotine patches and nicotine mini-lozenges, starting on the target quit day (TQD). Participants who smoke more than 10 cigarettes/day will start with a 21 mg patch for 20 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 22 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline. Receives: Drug: Extended Duration Combination NRT; Behavioral: Intensive Counseling |
| 24-week C-NRT with 4-Week Preparation C-NRT and Intensive Counseling | Active comparator | Participants randomized to this intervention will receive 14 mg patches starting 4 weeks prior to the target quit day (TQD). Starting on the TQD, participants will receive 24 weeks of nicotine patches and nicotine mini-lozenges. Participants who smoke >10 cigarettes/day will start with a 21 mg patch for 20 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 22 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline. Receives: Drug: Preparation Combination NRT and Extended Duration Combination NRT; Behavioral: Intensive Counseling |
What is being measured
The primary outcome is the main question the study is designed to answer.
Intent-to-treat Biochemically Verified 7-day Point Prevalence Abstinence
Participants will be asked to report on any smoking in the last seven days at a follow-up phone interview scheduled to occur 12-months post-target quit day (post-TQD). Those claiming complete abstinence (not even a puff from a cigarette) in the last seven days at this follow-up interview will be asked to provide a saliva sample for biochemical verification of self-reported abstinence via cotinine testing. Participants who report abstinence in the last 7 days at this visit but have a cotinine level >10ng/mL or who do not have provide a cotinine result will be considered to be smoking. Reported here as participant count of those considered Smoking and Abstinent per condition.
Measured: 12 months post-target quit day (TQD)
Secondary outcomes (2)
Implementation Cost Per Participant
The per participant implementation cost (minus research-related costs) for each intervention will be computed from a payer perspective. For each intervention, the total implementation cost will be divided by the number of participants randomized to the intervention to determine the implementation cost per participant in US dollars.
Measured: 12 months post-target quit day (TQD)
Cost Per Quit
The cost per quit will be determined by computing total implementation cost (minus research-related costs) from a payer perspective and dividing by the number of participants who quit smoking, as verified by 7-day point prevalence abstinence at 12 months post-TQD. Cost per quit will be reported as US dollars per individual who quit smoking.
Measured: 12 months post-target quit day (TQD)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted6 Dec 2019
- Study start10 Dec 2020
- Primary completion8 May 2025
- Study completion8 May 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Nicotine DependenceStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- Factorial
- Model description
- Daily smokers will be recruited from primary care to participate in a fully crossed, 2x2x2x2 factorial experiment (N=608) that evaluates 4 different factors: 1) Medication Type (Varenicline vs. Combination NRT \[C-NRT\]), 2) Preparation Medication (4 Weeks vs. Standard), 3) Medication Duration (Extended \[24 weeks\] vs. Standard \[12 weeks\]); and 4) Counseling (Intensive vs. Minimal).
- Masking
- None (open label)
- Enrolment
- 538 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Wisconsin, Madison
- Sponsor type
- University, hospital or other
- Collaborators
- National Cancer Institute (NCI)
- Responsible party
- Sponsor
- Investigators
- Megan E Piper, PhD, Study director, University of Wisconsin, Madison
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04188873
- Sponsor's protocol ID
- 2019-0054
- Other IDs
- 2P01CA180945, A534253, SMPH/MEDICINE/MEDICINE*G, Protocol Version 10/9/2023
- Status last verified
- May 2026
- First submitted
- 4 Dec 2019
- Last updated
- 17 Jun 2026
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- Yes: We will make the final de-identified datasets available in standard file formats by request from other researchers in a timely manner (no later than the acceptance for publication of the main findings from the final dataset).
Publications
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
Study at a glance
From the registry record, last updated by the sponsor on 17 Jun 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Optimized Chronic Care for Smokers: Developing and Implementing Integrated Clinical and Systems Interventions in Primary Care - Cessation Trial
- ClinicalTrials.gov ID
- NCT04188873
- Acronym / sponsor ID
- 2019-0054
- Conditions
- Nicotine Dependence
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 538 participants (actual)
- Lead sponsor
- University of Wisconsin, MadisonUniversity, hospital or other
- Collaborators
- National Cancer Institute (NCI)
- Study start
- 10 Dec 2020 (actual)
- Primary completion
- 8 May 2025 (actual)
- Study completion
- 8 May 2025 (actual)
- First posted
- 6 Dec 2019 (actual)
- Results
- Posted 17 Jun 2026
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This project will use the Multiphase Optimization Strategy (MOST) to guide the development of optimized treatment strategies for the two most effective smoking cessation medications (Combination Nicotine Replacement [C-NRT] and varenicline). The investigators will recruit daily smokers from primary care to participate in a fully crossed, 2x2x2x2 factorial experiment (N=608) that evaluates 4 different factors: 1) Medication Type (Varenicline vs. C-NRT), 2) Preparation Medication (4 Weeks vs. Standard), 3) Medication Duration (Extended [24 weeks] vs. Standard [12 weeks]); and 4) Counseling (Intensive vs. Minimal). Participants will complete assessments one week pre-quit and then assessments of smoking status, treatment use, side effects, potential treatment mechanisms (e.g., withdrawal, self-efficacy) during the first week post-target quit date (TQD) and at Weeks 2, 4, 12, 20, 26, and 52 post-target quit date. These data will be used to examine the main and interactive effects of these four factors on various outcomes, with biochemically confirmed 12-month abstinence serving as the primary outcome. These data will also be used to determine which factors and combinations of factors are most effective with regard to 12-month biochemically confirmed abstinence and cost, thereby identifying optimized varenicline and C-NRT treatments, with each developed to yield especially great benefit. These optimized treatments will then be tested in the Optimized Care Project. The investigators will also examine the relative effects of each medication on particular outcomes (e.g., 12-month abstinence).
Detailed description
Design and Objective: The Cessation Screening Project is a 4-factor factorial screening experiment (i.e., 2x2x2x2 = 16 experimental conditions) designed to identify the most promising intervention components that are especially effective and cost-effective with regard to their main and interactive effects on 12-month biochemically verified abstinence. This design will allow us to: 1) detect main effects and interactions within the factorial experiment and identify especially effective regimens for varenicline and for (Combination Nicotine Replacement) C-NRT; 2) compare the relative effectiveness of varenicline and C-NRT; and 3) identify the most effective and cost-effective counseling intensity to use with the optimized medication regimens. Finally, these results will allow us to identify two optimized treatment packages for use with primary care smokers interested in quitting: packages that include both counseling and pharmacotherapies optimized on the bases of effectiveness and cost.
Recruitment and Participants: Participants (N=608) will be primary care patients from 12 primary care clinics in two Wisconsin healthcare systems. Smokers will be identified via the healthcare system electronic health record (EHR). All EHR-identified smokers in a clinic will receive a mailed invitation to find out more about smoking treatment by calling a healthcare system Care Manager (CM). In addition, using an opt-out strategy, Medical Assistants (MAs), using an EHR-guided prompt, will inform all identified smokers seen at in-person or tele-health visits that they will be contacted by the CM unless the participant indicates s/he wants to opt-out. The participant contact information will then be automatically sent to the CM unless the participant opts out; the investigators have developed and used this workflow successfully in their past research. The CM will call and tell patients about the smoking cessation options available for them including the availability of this smoking cessation study. If patients are interested, the CM will obtain oral assent for screening and sharing contact, primary care team, and screening data with the research team before screening patients for eligibility. Eligible patients will learn more about the study and have a chance to ask questions and provide verbal informed consent. Finally, participants will complete a brief series of questions and then the CM will schedule a call with the study staff (i.e., a Health Counselor) in the database to initiate treatment and complete study assessments. Participants interested in quitting but not eligible for this study will be electronically referred to the Wisconsin Tobacco Quit Line and/or their primary care provider (PCP) by the CM.
Those who agree to and pass the screening for the inclusion/exclusion criteria for study participation will be asked to complete an oral consent and HIPAA authorization process next. After the patient provides oral consent, the CM will notify the patient's PCP via EHR that the patient has volunteered for a study with C-NRT or varenicline. The PCP will notify the CM via the EHR that the patient is medically eligible to receive either agent, as required by the collaborating healthcare systems. This will occur within 5 business days. The PCP will be notified via EHR of the patient's treatment assignment and of study-related serious adverse events or adverse events that prompt medication discontinuation that may occur. Care coordination with the PCP will occur via Tobacco Care Manager entry of data in the patient EHR.
Procedures and Measures: At the second study call, participants (N=608) will be randomized to one level of each of 4 factors: 1) Medication Type (Varenicline vs. C-NRT), 2) Preparation Medication (4 weeks vs. Standard), 3) Medication Duration (Extended vs. Standard), and 4) Counseling (Intensive vs. Minimal). Participants will be told their treatment condition at Call 2, set a target quit date (TQD), and instructed how to use their study medications. Medications will be mailed following this call, along with a handout that describes: 1) when to begin taking study medication; 2) the type and doses involved; 3) how and when to obtain the next month's medication; and 4) complete instructions on proper medication use, including information from the package insert and contact information if they have questions regarding their medication and/or symptoms they experience. Participants will be mailed all Preparation Medication as well as one month of post-quit study medication after Call 2. They will need to call in to a study line to request that more medication be mailed to them (Standard Duration participants will call one time to receive their final 2 months of medication; Extended Duration participants will call once to get 2 additional months of medication and again to get the remaining 3 months of study medication). Participants will also receive a counseling handout with their medications; those randomized to intensive counseling will receive a Quit Plan listing their target quit day and when they start the medications and those randomized to minimal counseling will receive the mobile health (mHealth) handout.
Participants will complete phone assessments one week pre-quit, during the first week post-target quit date (TQD) and at Weeks 2, 4, 12, 20, 26, and 52 post-TQD.
Outcomes: The primary outcome for this study is biochemically confirmed, point-prevalence abstinence at 12 months post-TQD (Primary Aim 1). The secondary outcome is cost effectiveness in which the costs of implementing each intervention (minus research-related costs) will be computed from a payer perspective. Costs will be combined with the intent-to-treat biochemically verified 7-day point prevalence abstinence at 12 months post-TQD to determine the cost per quit.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Factorial
- Masking
- None (open label)
- Number of arms
- 16
- Model description
- Daily smokers will be recruited from primary care to participate in a fully crossed, 2x2x2x2 factorial experiment (N=608) that evaluates 4 different factors: 1) Medication Type (Varenicline vs. Combination NRT [C-NRT]), 2) Preparation Medication (4 Weeks vs. Standard), 3) Medication Duration (Extended [24 weeks] vs. Standard [12 weeks]); and 4) Counseling (Intensive vs. Minimal).
| Arm | Type | Receives |
|---|---|---|
| 12-week Varenicline with Minimal Counseling | Active comparator | Drug: Standard Duration Varenicline, Behavioral: Minimal CounselingParticipants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 1 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily until 11 weeks post-TQD. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt. |
| 12-week Varenicline with 4-Week Preparation Varenicline and Minimal Counseling | Active comparator | Drug: Preparation Varenicline and Standard Duration Varenicline, Behavioral: Minimal CounselingParticipants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 4 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily for the next 3 weeks pre-TQD and until 12 weeks post-TQD. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt. |
| 24-week Varenicline with Minimal Counseling | Active comparator | Drug: Extended Duration Varenicline, Behavioral: Minimal CounselingParticipants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 1 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily until 23 weeks post-TQD. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt. |
| 24-week Varenicline with 4-Week Preparation Varenicline and Minimal Counseling | Active comparator | Drug: Preparation Varenicline and Extended Duration Varenicline, Behavioral: Minimal CounselingParticipants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 4 weeks prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily for the next 3 weeks pre-TQD and until 24 weeks post-TQD. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt. |
| 12-week Varenicline with Intensive Counseling | Active comparator | Drug: Standard Duration Varenicline, Behavioral: Intensive CounselingParticipants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 1 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily until 11 weeks post-TQD. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline. |
| 12-week Varenicline with 4-Week Preparation Varenicline and Intensive Counseling | Active comparator | Drug: Preparation Varenicline and Standard Duration Varenicline, Behavioral: Intensive CounselingParticipants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 4 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily for the next 3 weeks pre-TQD and until 11 weeks post-TQD. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline. |
| 24-week Varenicline with Intensive Counseling | Active comparator | Drug: Extended Duration Varenicline, Behavioral: Intensive CounselingParticipants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 1 week prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily until 23 weeks post-TQD. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline. |
| 24-week Varenicline with 4-Week Preparation Varenicline and Intensive Counseling | Active comparator | Drug: Preparation Varenicline and Extended Duration Varenicline, Behavioral: Intensive CounselingParticipants randomized to this intervention will receive one 0.5 mg pill for the first 3 days, starting 4 weeks prior to the target quit day (TQD). They will then use one 0.5 mg pill twice daily for the next 4 days. After the first week of study medication ramp up, participants will use one 1 mg pill twice daily for the next 3 weeks pre-TQD and until 24 weeks post-TQD. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline. |
| 12-week C-NRT with Minimal Counseling | Active comparator | Drug: Standard Duration Combination NRT, Behavioral: Minimal CounselingParticipants randomized to this intervention will receive 12 weeks of nicotine patches and nicotine mini-lozenges to use starting on their quit day. Participants who smoke more than 10 cigarettes/day will start with a 21 mg patch for 8 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 10 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt. |
| 12-week C-NRT with 4-Week Preparation C-NRT and Minimal Counseling | Active comparator | Drug: Preparation Combination NRT and Standard Duration Combination NRT, Behavioral: Minimal CounselingParticipants randomized to this intervention will receive 14 mg patches starting 4 weeks prior to the target quit day (TQD). Then, starting on the TQD, participants will receive 12 weeks of nicotine patches and nicotine mini-lozenges. Participants who smoke >10 cigarettes/day will start with a 21 mg patch for 8 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 10 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants will receive a brief 15-30 minute phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt. |
| 24-week C-NRT with Minimal Counseling | Active comparator | Drug: Extended Duration Combination NRT, Behavioral: Minimal CounselingParticipants randomized to this intervention will receive 24 weeks of nicotine patches and nicotine mini-lozenges, starting on the target quit day (TQD). Participants who smoke more than 10 cigarettes/day will start with a 21 mg patch for 20 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 22 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants randomized to this intervention will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt. |
| 24-week C-NRT with 4-Week Preparation C-NRT and Minimal Counseling | Active comparator | Drug: Preparation Combination NRT and Extended Duration Combination NRT, Behavioral: Minimal CounselingParticipants randomized to this intervention will receive 14 mg patches starting 4 weeks prior to the target quit day (TQD). Then, starting on the TQD, participants will receive 24 weeks of nicotine patches and nicotine mini-lozenges. Participants who smoke more than 10 cigarettes/day will start with a 21 mg patch for 20 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 22 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants will receive a brief (15-30 minute) phone or video counseling session 1 week prior to the TQD to promote engagement with free mobile health resources and then a brief (10-20 minute) follow-up phone or video session during the first week post-TQD to mimic a nurse or clinician follow-up after a quit attempt. |
| 12-week C-NRT with Intensive Counseling | Active comparator | Drug: Standard Duration Combination NRT, Behavioral: Intensive CounselingParticipants randomized to this intervention will receive 12 weeks of nicotine patches and nicotine mini-lozenges to use starting on their quit day. Participants who smoke more than 10 cigarettes/day will start with a 21 mg patch for 8 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 10 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline. |
| 12-week C-NRT with 4-Week Preparation C-NRT and Intensive Counseling | Active comparator | Drug: Preparation Combination NRT and Standard Duration Combination NRT, Behavioral: Intensive CounselingParticipants randomized to this intervention will receive 14 mg patches starting 4 weeks prior to the target quit day (TQD). Starting on the TQD, participants will receive 12 weeks of nicotine patches and nicotine mini-lozenges. Participants who smoke >10 cigarettes/day will start with a 21 mg patch for 8 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 10 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline. |
| 24-week C-NRT with Intensive Counseling | Active comparator | Drug: Extended Duration Combination NRT, Behavioral: Intensive CounselingParticipants randomized to this intervention will receive 24 weeks of nicotine patches and nicotine mini-lozenges, starting on the target quit day (TQD). Participants who smoke more than 10 cigarettes/day will start with a 21 mg patch for 20 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 22 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants randomized to this intervention will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline. |
| 24-week C-NRT with 4-Week Preparation C-NRT and Intensive Counseling | Active comparator | Drug: Preparation Combination NRT and Extended Duration Combination NRT, Behavioral: Intensive CounselingParticipants randomized to this intervention will receive 14 mg patches starting 4 weeks prior to the target quit day (TQD). Starting on the TQD, participants will receive 24 weeks of nicotine patches and nicotine mini-lozenges. Participants who smoke >10 cigarettes/day will start with a 21 mg patch for 20 weeks, and then titrate down to a 14 mg patch for 2 weeks and then a 7 mg patch for 2 weeks. Participants who smoke 5-10 cigarettes/day will be given 22 weeks of 14 mg patches and then 2 weeks of 7 mg patches. Participants will receive 2 mg mini-lozenges. Participants will receive four 15-20 minute phone or video counseling sessions (1 prior to the TQD, 1 during the first week post-TQD and during Weeks 2 and 4 post-TQD). The counseling is designed to produce intra-treatment support and skill training, consistent with the Public Health Service (PHS) Clinical Practice Guideline. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Smoking >4 cigarettes/day for the previous 6 months
- Able to read, write, and speak English
- If currently using nicotine replacement therapy (NRT), agreeing to use only study medication for the duration of the study
- Medically eligible to use study medications
- If the participant is a woman of childbearing potential, using an approved method of birth control during treatment
Key exclusion criteria (2 listed)
- Currently taking bupropion or varenicline
- Suicidal ideation in the last 12 months or any suicide attempts in the past 10 years
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Preparation Varenicline and Standard Duration Varenicline16 weeks of varenicline starting 4 weeks pre-quit | Drug | 12-week Varenicline with 4-Week Preparation Varenicline and Intensive Counseling, 12-week Varenicline with 4-Week Preparation Varenicline and Minimal Counseling |
| Preparation Varenicline and Extended Duration Varenicline28 weeks of varenicline starting 4 weeks pre-quit | Drug | 24-week Varenicline with 4-Week Preparation Varenicline and Intensive Counseling, 24-week Varenicline with 4-Week Preparation Varenicline and Minimal Counseling |
| Standard Duration Varenicline12 weeks of varenicline | Drug | 12-week Varenicline with Intensive Counseling, 12-week Varenicline with Minimal Counseling |
| Extended Duration Varenicline24 weeks of varenicline | Drug | 24-week Varenicline with Intensive Counseling, 24-week Varenicline with Minimal Counseling |
| Preparation Combination NRT and Standard Duration Combination NRT16 weeks of nicotine patch + nicotine mini-lozenge starting 4 weeks pre-quit | Drug | 12-week C-NRT with 4-Week Preparation C-NRT and Intensive Counseling, 12-week C-NRT with 4-Week Preparation C-NRT and Minimal Counseling |
| Preparation Combination NRT and Extended Duration Combination NRT28 weeks of nicotine patch + nicotine mini-lozenge starting 4 weeks pre-quit | Drug | 24-week C-NRT with 4-Week Preparation C-NRT and Intensive Counseling, 24-week C-NRT with 4-Week Preparation C-NRT and Minimal Counseling |
| Standard Duration Combination NRT12 weeks of nicotine patch + nicotine mini-lozenge | Drug | 12-week C-NRT with Intensive Counseling, 12-week C-NRT with Minimal Counseling |
| Extended Duration Combination NRT24 weeks of nicotine patch + nicotine mini-lozenge | Drug | 24-week C-NRT with Intensive Counseling, 24-week C-NRT with Minimal Counseling |
| Intensive Counseling4 phone or video counseling sessions | Behavioural | 12-week C-NRT with 4-Week Preparation C-NRT and Intensive Counseling, 12-week C-NRT with Intensive Counseling, 12-week Varenicline with 4-Week Preparation Varenicline and Intensive Counseling, 12-week Varenicline with Intensive Counseling, 24-week C-NRT with 4-Week Preparation C-NRT and Intensive Counseling, 24-week C-NRT with Intensive Counseling, 24-week Varenicline with 4-Week Preparation Varenicline and Intensive Counseling, 24-week Varenicline with Intensive Counseling |
| Minimal Counseling2 brief phone or video counseling sessions | Behavioural | 12-week C-NRT with 4-Week Preparation C-NRT and Minimal Counseling, 12-week C-NRT with Minimal Counseling, 12-week Varenicline with 4-Week Preparation Varenicline and Minimal Counseling, 12-week Varenicline with Minimal Counseling, 24-week C-NRT with 4-Week Preparation C-NRT and Minimal Counseling, 24-week C-NRT with Minimal Counseling, 24-week Varenicline with 4-Week Preparation Varenicline and Minimal Counseling, 24-week Varenicline with Minimal Counseling |
Primary outcome
Intent-to-treat Biochemically Verified 7-day Point Prevalence Abstinence
Time frame: 12 months post-target quit day (TQD)
Participants will be asked to report on any smoking in the last seven days at a follow-up phone interview scheduled to occur 12-months post-target quit day (post-TQD). Those claiming complete abstinence (not even a puff from a cigarette) in the last seven days at this follow-up interview will be asked to provide a saliva sample for biochemical verification of self-reported abstinence via cotinine testing. Participants who report abstinence in the last 7 days at this visit but have a cotinine level >10ng/mL or who do not have provide a cotinine result will be considered to be smoking. Reported here as participant count of those considered Smoking and Abstinent per condition.
2 secondary outcomes
Implementation Cost Per Participant
Time frame: 12 months post-target quit day (TQD)
Cost Per Quit
Time frame: 12 months post-target quit day (TQD)
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 17 Jun 2026.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Derived from this study: PubMed 37335995Theodoulou 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.
- Individual participant dataSharing planned: Yes. We will make the final de-identified datasets available in standard file formats by request from other researchers in a timely manner (no later than the acceptance for publication of the main findings from the final dataset).
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Megan E Piper, PhD study director
University of Wisconsin, Madison
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing Preparation Varenicline and Standard Duration Varenicline, Preparation Varenicline and Extended Duration Varenicline and Standard Duration Varenicline in people with Nicotine Dependence, run by University of Wisconsin, Madison at 2 sites 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 5 inclusion and 2 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 17 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites 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 17 Jun 2026). 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?
Intent-to-treat Biochemically Verified 7-day Point Prevalence Abstinence (time frame: 12 months post-target quit day (TQD)). 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 NCT04188873, which also lists 1 linked publication.
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 17 Jun 2026; AzTrials last refreshed its copy on 27 Oct 2026.