Subsequent Smoking Cessation Treatment After Varenicline or Nicotine Replacement—Reply

In Reply Dr Lang provides thoughtful comments about our study on smoking cessation after treatment failure with varenicline or combined nicotine replacement therapy (CNRT). To the point about using 6 weeks as a defining time point for assessing abstinence, as we noted in the article, 6 weeks, while an arbitrary cutoff in some respects, was chosen because the majority of studies on smoking cessation suggest that most relapse occurs within the first 2 weeks of the target quit date. While it is true that some smokers who are unable to quit or relapse in that time frame may eventually succeed in quitting, it is also true that with varenicline in particular, most of those who quit do so in the first few weeks. Therefore, the midpoint of a typical 12-week course of treatment was selected as a decision point for further treatment. Moreover, our study showed that nonabstainers who were rerandomized to continue the same pharmacotherapy quit less often in comparison with the other treatment options, particularly increasing the dose of either varenicline or CNRT. Our data do not suggest, nor did we wish to imply, that the same treatment would not be effective at some future time point; rather, for any given quit attempt, an alternative treatment should be considered when an initial 6-week treatment of either CNRT or varenicline does not lead to abstinence.