Metabolism Informed Smoking Treatment: The MIST RCT

NCT ID: NCT04590404

Last Updated: 2025-12-05

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

606 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-11-17

Study Completion Date

2024-11-22

Brief Summary

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This phase 3 randomized controlled trial will test Metabolism-Informed Smoking Treatment (MIST), a precision approach to smoking treatment that biologically tailors medication selection to nicotine metabolism.

Detailed Description

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This is a randomized controlled trial to compare effects of MIST versus usual care (UC) interventions on the outcomes below.

Objectives:

* Abstinence as defined by biochemically-verified self-reported 7-day point prevalence abstinence at 6 m (1° study outcome) and 12 m (2° outcome).
* Clinical practice implementation as measured by participant self-reported medication adherence at months 1 and 3, self-reported receipt of prescription for smoking cessation medication after hospital discharge, and whether the prescription was tailored to the NMR result.

Exploratory Objective:

\- Longitudinal assessment of health care utilization visits (ER and hospitalization) for 12 months following hospital discharge.

Conditions

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Smoking

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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MIST (Metabolism-Informed Smoking Treatment)

At hospital discharge, participants randomized to the MIST precision care arm will receive a prescription for medication (either varenicline or NRT). Post discharge, participants will receive automated phone calls via TelASK to promote continued engagement. Medication prescriptions will be informed by nicotine metabolism (i.e., NMR result) such that faster metabolizers are prescribed varenicline and slower metabolizers are prescribed NRT.

Group Type EXPERIMENTAL

Post-discharge automated phone calls (IVR) with option to connect with a tobacco coach.

Intervention Type BEHAVIORAL

Automated calls to assess smoking status, medication use, and additional support for quit attempt.

Nicotine Replacement Therapy

Intervention Type DRUG

FDA-approved forms of nicotine replacement therapy for smoking cessation.

Varenicline

Intervention Type DRUG

FDA-approved smoking cessation medication.

Metabolism Informed Smoking Treatment (Nicotine metabolite ratio (NMR)-based selection of pharmacotherapy)

Intervention Type OTHER

Nicotine metabolite ratio (NMR)-based selection of pharmacotherapy. NMR is a blood test to measure how fast the body breaks down nicotine.

Usual Care

At hospital discharge, participants randomized to the Usual Care arm will receive a prescription for medication (either varenicline or NRT). Post discharge, participants will receive automated phone calls via TelASK to promote continued engagement. Medication prescription will not be informed by nicotine metabolism.

Group Type ACTIVE_COMPARATOR

Post-discharge automated phone calls (IVR) with option to connect with a tobacco coach.

Intervention Type BEHAVIORAL

Automated calls to assess smoking status, medication use, and additional support for quit attempt.

Nicotine Replacement Therapy

Intervention Type DRUG

FDA-approved forms of nicotine replacement therapy for smoking cessation.

Varenicline

Intervention Type DRUG

FDA-approved smoking cessation medication.

Interventions

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Post-discharge automated phone calls (IVR) with option to connect with a tobacco coach.

Automated calls to assess smoking status, medication use, and additional support for quit attempt.

Intervention Type BEHAVIORAL

Nicotine Replacement Therapy

FDA-approved forms of nicotine replacement therapy for smoking cessation.

Intervention Type DRUG

Varenicline

FDA-approved smoking cessation medication.

Intervention Type DRUG

Metabolism Informed Smoking Treatment (Nicotine metabolite ratio (NMR)-based selection of pharmacotherapy)

Nicotine metabolite ratio (NMR)-based selection of pharmacotherapy. NMR is a blood test to measure how fast the body breaks down nicotine.

Intervention Type OTHER

Other Intervention Names

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Chantix

Eligibility Criteria

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Inclusion Criteria

* be 18 years or older
* be enrolled in an insurance plan that supports prescription coverage for smoking cessation medication (such as Medicare part D, Medicaid, or private insurance) to facilitate bedside delivery of medications prior to hospital discharge
* have a regular provider/PCP
* agree to quit or try to quit smoking upon hospital discharge
* be a daily smoker when smoking normally during the month prior to entering the hospital
* be medically eligible to use varenicline
* be medically eligible to use nicotine replacement therapy
* have received discharge medication recommendations from a tobacco counselor
* agree to take smoking cessation medication (i.e., varenicline OR nicotine replacement therapy) home and consider using it
* have a cell phone or landline that can be reached directly (i.e., without transfer)
* have a permanent address where they live and can receive mail
* estimated life expectancy of at least one year or greater

Exclusion Criteria

* insufficient time to perform and complete the enrollment process
* barrier to effective communication (including low English proficiency)
* not cognitively able to participate in the study
* too ill, on hospice, or physically unable to participate in the follow-up process
* previously completed the MIST study or is currently enrolled in a quit smoking study that involves a medication-based treatment
* estimated life expectancy of less than one year
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role collaborator

National Institutes of Health (NIH)

NIH

Sponsor Role collaborator

Vanderbilt-Ingram Cancer Center

OTHER

Sponsor Role lead

Responsible Party

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Hilary Tindle

Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Hilary Tindle, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Vanderbilt University Medical Center

Locations

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Vanderbilt University Medical Center ViTAL, Vanderbilt Center for Tobacco, Addiction, and Lifestyle General Internal Medicine and Public Health 2525 West End Ave, Suite 450

Nashville, Tennessee, United States

Site Status

Countries

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United States

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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5R01CA232516-03

Identifier Type: NIH

Identifier Source: secondary_id

View Link

VICC THO 2046

Identifier Type: -

Identifier Source: org_study_id

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