P
age
2
•Prescrire International Special Edition 2015/Volume 24 N°158
A
Translated from
Rev Prescrire
June 2014; 34 (368): 405
Repeating the same mistake
It is easy to stop smoking… but giving up
for good is difficult, whichever method is
used. There are less traumatic methods but
also more radical methods, such as abrupt
removal of smoking paraphernalia (packets,
rolling machines, lighters and ashtrays), and
distancing oneself from friends who smoke
and even one’s old life. Other smokers turn to
smoking cessation drugs. Among the drugs
available, the best choice is nicotine, which
has an acceptable harm-benefit balance.
Although, as with other methods, it is easy to
stop smoking, but…
The use of other smoking cessation drugs
is more controversial. Varenicline falls into
this category. It is more dangerous than nico-
tine. And with varenicline too, it is easy to
stop smoking… but relapse is common.
The summary of product characteristics
(SPC) for varenicline has been amended
to encourage the use of a second course of
varenicline for patients who have relapsed
after a previous attempt to quit smoking with
this drug (see Prescrire Int 152, p. 208). Does
varenicline have a better harm-benefit bal-
ance the second time around?
A comparative trial showed that during a
second course of varenicline, it is easy to
stop smoking... but no more so than the first
time. In terms of harms, doubling the duration
of exposure to the drug also doubles expo-
sure to its serious adverse effects, such as
myocardial infarction and suicide. Varenicline
also provokes immune-mediated adverse
effects, such as Stevens-Johnson syndrome,
the incidence and severity of which may be
increased by re-exposure, related to an in-
crease in anti-varenicline antibodies.
The European Medicines Agency’s decision
to authorise a repeat course of varenicline
for a second attempt at smoking cessation
brings to mind the Latin expression: “Errare
humanum est, perseverare diabolicum”. Why
persist in repeating the same mistake and ex-
pect a different result?
Especially since it is easy to stop smoking,
but…
Prescrire
Editorial
Prescrire Int • September 2014
