Cigarette Smoking, Smoking Cessation, Smoking (Tobacco) Addiction
Conditions
Keywords
smoking cessation, nicotine film, nicotine delivery, random nicotine delivery
Brief summary
The objective of this study is to determine whether treatment with random nicotine delivery via a nicotine film both before and after the target quit date will facilitate smoking cessation relative to treatment with steady state delivery or placebo. The investigators hypothesize that smoking cessation will be greater in subjects assigned to a random nicotine delivery regimen (as compared to those assigned to a steady state or placebo regimen). The nicotine film product is not part of the standard of care and is not available in non-investigational settings in the United States.
Detailed description
This project is a prospective parallel-group, randomized, double-blind, placebo-controlled study in which 45 current cigarette smokers who are interested in quitting will be randomly allocated to one of three possible nicotine film treatment regimens: 1. Random nicotine delivery (a combination of four 0 mg and 4 mg films daily not to exceed three non-consecutive 4 mg films in one day and to maintain an average of 8 mg of nicotine per day through 7 days for 6 weeks total). 2. Steady state nicotine delivery (2, 2, 2, 2 mg films daily for 6 weeks total) 3. Placebo delivery (0, 0, 0, 0 mg films daily for 6 weeks total) Prior to assignment in one of the above treatment groups, all participants will take part in a 1-week baseline period to assess normal smoking behavior and nicotine dependence. Following randomization to their assigned treatment group at Visit 2, participants will be instructed to smoke cigarettes as they feel necessary over the next two weeks while using the nicotine films as directed (i.e., one film every 3-4 hours for a total of four films per day). After two weeks of pre-cessation treatment, participants will be asked completely cease cigarette smoking and to only use their assigned nicotine films as directed. Participants will be supported in their quitting efforts with regular contacts both in person at the Penn State Milton S. Hershey Medical Center and over the phone.
Interventions
DRUGNicotine Film
Three doses of nicotine films will be used in this project: 0 mg, 2 mg, and 4 mg. The active pharmaceutical ingredient in the nicotine film product is nicotine polacrilex (20%, USP). The film has a muco-adhesive property and allows nicotine to be absorbed through the oral mucosa. After placement in the oral cavity, the nicotine film dissolves in less than five minutes. The film is in the form of 1 inch x 1 inch square and weighs about 100 mg. Nicotine films are not available in the United States in a non-investigational setting.
Sponsors
National Institute on Drug Abuse (NIDA)
Milton S. Hershey Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 55 Years
Healthy volunteers
Yes
Inclusion criteria
* Aged 18-55 * Smoke ≥10 cigarettes/day for at least the past 12 months * Exhaled CO measurement ≥6 ppm at baseline visit * Interested in completely ceasing cigarette consumption and using a nicotine film product as directed * Willing to attend regular visits over a 6-week period (not planning to move, not planning extended vacation, no planned surgeries) * Able to read and write in English * Able to understand and consent to study procedures
Exclusion criteria
* Unstable or significant medical conditions and conditions such as elevated blood pressure (systolic \>159 mmHg or diastolic \>99mmHg at baseline), COPD, and those conditions that are likely to affect biomarker data such as kidney or liver disease * Individuals with sodium-restricted diet, heart disease, recent heart attack, irregular heartbeat, stomach ulcers, or diabetes as well as those taking prescription medications for depression or asthma as indicated under Warnings section on FDA approved NRT Drug Facts Label * More than weekly use in the past 3 months of illegal drugs or prescription drugs that are not being used for medically prescribed purposes * Use of non-cigarette nicotine delivery product in the prior 7 days (including cigars, pipes, chew, snus, hookah, electronic cigarette and marijuana mixed with tobacco) * Use of an FDA approved cessation medication in the past 7 days (any NRT, Chantix, Wellbutrin) * Women who are pregnant (verified by urine pregnancy test at baseline visit), trying to become pregnant, or nursing * Uncontrolled mental illness or substance abuse or inpatient treatment for these conditions in the past 6 months * Any previous adverse reaction to NRT * Any other condition, serious illness, or situation that would, in the investigator's opinion, make it unlikely that the participant could comply with the study protocol * Other member of household currently participating in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Number of Cigarettes Smoked Per Day (CPD) | Baseline and 4 weeks after Target Quit Date | CPD is measured with the use of daily cigarette logs which are completed daily by participants and returned to the study center at each visit. The CPD measure will be the average of the past 7 days. |
| Change in Exhaled Carbon Monoxide (CO) Measurement | Baseline and 4 weeks after Target Quit Date | Mean change in exhaled CO (parts per million \[ppm\]) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Questionnaire of Smoking Urges-Brief (QSU-Brief) Total Score | Baseline and 4 weeks after Target Quit Date | The QSU-Brief, with a possible total score range of 10 to 70, is an instrument used to measure cigarette craving. A score of 10 on this scale indicates very low cigarette craving, while a score of 70 indicates very high cigarette craving. |
| Change in Fagerstrom Test for Nicotine Dependence (FTND) Total Score | Baseline and 4 weeks after Target Quit Date | Nicotine dependence will be assessed via the FTND, a measure with total scores ranging from 0 (very low dependence) to 10 (very high dependence). |
| Subjective Ratings Scale for Nicotine Film Use | 4 weeks after Target Quit Date | The scale is comprised of 21 items. Each item is rated on a scale 1-7, where 1 is equal to not at all and 7 is equal to extremely. The total score is the average score of all 21 items. The total score ranges from 1-7. |
| Side Effects From Nicotine Film Use | 4 weeks after Target Quit Date | Total score ranges from 0 - 36 with lower scores indicating lesser side effects. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Random Nicotine Delivery One 0 mg or 4 mg nicotine film every 3-4 hours for a total of four films per day (not to exceed three non-consecutive 4 mg films in one day) for 6 weeks.
Nicotine Film: Three doses of nicotine films will be used in this project: 0 mg, 2 mg, and 4 mg.
The active pharmaceutical ingredient in the nicotine film product is nicotine polacrilex (20%, USP). The film has a muco-adhesive property and allows nicotine to be absorbed through the oral mucosa. After placement in the oral cavity, the nicotine film dissolves in less than five minutes. The film is in the form of 1 inch x 1 inch square and weighs about 100 mg. Nicotine films are not available in the United States in a non-investigational setting. | 15 |
| Steady State Nicotine Delivery One 2 mg nicotine film every 3-4 hours for a total of four films per day for 6 weeks.
Nicotine Film: Three doses of nicotine films will be used in this project: 0 mg, 2 mg, and 4 mg.
The active pharmaceutical ingredient in the nicotine film product is nicotine polacrilex (20%, USP). The film has a muco-adhesive property and allows nicotine to be absorbed through the oral mucosa. After placement in the oral cavity, the nicotine film dissolves in less than five minutes. The film is in the form of 1 inch x 1 inch square and weighs about 100 mg. Nicotine films are not available in the United States in a non-investigational setting. | 15 |
| Placebo Control One 0 mg nicotine film every 3-4 hours for a total of four films per day for 6 weeks.
Nicotine Film: Three doses of nicotine films will be used in this project: 0 mg, 2 mg, and 4 mg.
The active pharmaceutical ingredient in the nicotine film product is nicotine polacrilex (20%, USP). The film has a muco-adhesive property and allows nicotine to be absorbed through the oral mucosa. After placement in the oral cavity, the nicotine film dissolves in less than five minutes. The film is in the form of 1 inch x 1 inch square and weighs about 100 mg. Nicotine films are not available in the United States in a non-investigational setting. | 15 |
| Total | 45 |
Baseline characteristics
| Characteristic | Total | Random Nicotine Delivery | Steady State Nicotine Delivery | Placebo Control |
|---|---|---|---|---|
| Age, Continuous | 43.1 years STANDARD_DEVIATION 7.7 | 42.2 years STANDARD_DEVIATION 9.2 | 44.0 years STANDARD_DEVIATION 8.1 | 43.2 years STANDARD_DEVIATION 5.8 |
| Cigarettes Per Day | 18.4 Cigarettes per day STANDARD_DEVIATION 6.4 | 19.6 Cigarettes per day STANDARD_DEVIATION 7.7 | 18.8 Cigarettes per day STANDARD_DEVIATION 6.6 | 16.8 Cigarettes per day STANDARD_DEVIATION 4.5 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants | 0 Participants | 1 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 44 Participants | 15 Participants | 14 Participants | 15 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Fagerstrom Test for Nicotine Dependence Total Score | 4.7 Scores on a scale STANDARD_DEVIATION 1.5 | 5.0 Scores on a scale STANDARD_DEVIATION 1.4 | 4.9 Scores on a scale STANDARD_DEVIATION 1.1 | 4.3 Scores on a scale STANDARD_DEVIATION 1.8 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 42 Participants | 14 Participants | 15 Participants | 13 Participants |
| Region of Enrollment United States | 45 participants | 15 participants | 15 participants | 15 participants |
| Sex: Female, Male Female | 34 Participants | 10 Participants | 13 Participants | 11 Participants |
| Sex: Female, Male Male | 11 Participants | 5 Participants | 2 Participants | 4 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 15 | 0 / 15 | 0 / 15 |
| other Total, other adverse events | 9 / 15 | 11 / 15 | 8 / 15 |
| serious Total, serious adverse events | 0 / 15 | 0 / 15 | 0 / 15 |
Outcome results
Primary
Change in Exhaled Carbon Monoxide (CO) Measurement
Mean change in exhaled CO (parts per million \[ppm\])
Time frame: Baseline and 4 weeks after Target Quit Date
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Random Nicotine Delivery | Change in Exhaled Carbon Monoxide (CO) Measurement | -16 parts per million | Standard Deviation 18.6 |
| Steady State Nicotine Delivery | Change in Exhaled Carbon Monoxide (CO) Measurement | -5.9 parts per million | Standard Deviation 13.4 |
| Placebo Control | Change in Exhaled Carbon Monoxide (CO) Measurement | -10.5 parts per million | Standard Deviation 9.1 |
p-value: 0.2146ANOVA
Primary
Change in Number of Cigarettes Smoked Per Day (CPD)
CPD is measured with the use of daily cigarette logs which are completed daily by participants and returned to the study center at each visit. The CPD measure will be the average of the past 7 days.
Time frame: Baseline and 4 weeks after Target Quit Date
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Random Nicotine Delivery | Change in Number of Cigarettes Smoked Per Day (CPD) | -10.3 cigarettes per day | Standard Deviation 6.1 |
| Steady State Nicotine Delivery | Change in Number of Cigarettes Smoked Per Day (CPD) | -9.0 cigarettes per day | Standard Deviation 8 |
| Placebo Control | Change in Number of Cigarettes Smoked Per Day (CPD) | -7.6 cigarettes per day | Standard Deviation 5.3 |
p-value: 0.55ANOVA
Secondary
Change in Fagerstrom Test for Nicotine Dependence (FTND) Total Score
Nicotine dependence will be assessed via the FTND, a measure with total scores ranging from 0 (very low dependence) to 10 (very high dependence).
Time frame: Baseline and 4 weeks after Target Quit Date
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Random Nicotine Delivery | Change in Fagerstrom Test for Nicotine Dependence (FTND) Total Score | -1.1 FTND Total Score | Standard Deviation 1.44 |
| Steady State Nicotine Delivery | Change in Fagerstrom Test for Nicotine Dependence (FTND) Total Score | -.53 FTND Total Score | Standard Deviation 0.92 |
| Placebo Control | Change in Fagerstrom Test for Nicotine Dependence (FTND) Total Score | -.53 FTND Total Score | Standard Deviation 1.46 |
p-value: 0.4353ANOVA
Secondary
Change in Questionnaire of Smoking Urges-Brief (QSU-Brief) Total Score
The QSU-Brief, with a possible total score range of 10 to 70, is an instrument used to measure cigarette craving. A score of 10 on this scale indicates very low cigarette craving, while a score of 70 indicates very high cigarette craving.
Time frame: Baseline and 4 weeks after Target Quit Date
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Random Nicotine Delivery | Change in Questionnaire of Smoking Urges-Brief (QSU-Brief) Total Score | -.55 QSU Total Score | Standard Deviation 1.46 |
| Steady State Nicotine Delivery | Change in Questionnaire of Smoking Urges-Brief (QSU-Brief) Total Score | -.55 QSU Total Score | Standard Deviation 1.36 |
| Placebo Control | Change in Questionnaire of Smoking Urges-Brief (QSU-Brief) Total Score | -.11 QSU Total Score | Standard Deviation 0.97 |
p-value: 0.5642ANOVA
Secondary
Side Effects From Nicotine Film Use
Total score ranges from 0 - 36 with lower scores indicating lesser side effects.
Time frame: 4 weeks after Target Quit Date
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Random Nicotine Delivery | Side Effects From Nicotine Film Use | 17.77 score on a scale | Standard Deviation 4.32 |
| Steady State Nicotine Delivery | Side Effects From Nicotine Film Use | 15.36 score on a scale | Standard Deviation 3.32 |
| Placebo Control | Side Effects From Nicotine Film Use | 17.13 score on a scale | Standard Deviation 5.15 |
p-value: 0.404ANOVA
Secondary
Subjective Ratings Scale for Nicotine Film Use
The scale is comprised of 21 items. Each item is rated on a scale 1-7, where 1 is equal to not at all and 7 is equal to extremely. The total score is the average score of all 21 items. The total score ranges from 1-7.
Time frame: 4 weeks after Target Quit Date
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Random Nicotine Delivery | Subjective Ratings Scale for Nicotine Film Use | 3.32 score on a scale | Standard Deviation 0.71 |
| Steady State Nicotine Delivery | Subjective Ratings Scale for Nicotine Film Use | 2.82 score on a scale | Standard Deviation 0.46 |
| Placebo Control | Subjective Ratings Scale for Nicotine Film Use | 2.74 score on a scale | Standard Deviation 0.57 |
p-value: 0.0348ANOVA