Trial Outcomes & Findings for Metabolism Informed Smoking Treatment: The MIST RCT (NCT NCT04590404)

NCT ID: NCT04590404

Last Updated: 2025-12-05

Results Overview

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

606 participants

Primary outcome timeframe

6 months

Results posted on

2025-12-05

Participant Flow

Participants were recruited from a tertiary care hospital in the US Mid-South from November 17, 2020 to September 29, 2023.

5 participants were removed pre-randomization assignment by PI due to new information, discovered post-consent, indicating ineligibility.

Participant milestones

Participant milestones
Measure
MIST (Metabolism-Informed Smoking Treatment)
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. The MIST intervention used NMR to select medication (Fast Metabolizers NMR≥0.31-varenicline; Slow Metabolizers NMR \<0.31-NRT).
Guideline-Based Care
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. Medication was selected by shared decision making. Guideline-based care participants were not informed of NMR results.
Overall Study
STARTED
294
307
Overall Study
1-month Survey
259
271
Overall Study
3-month Survey
246
264
Overall Study
6-month Survey
247
261
Overall Study
12-month Survey
235
246
Overall Study
COMPLETED
271
288
Overall Study
NOT COMPLETED
23
19

Reasons for withdrawal

Reasons for withdrawal
Measure
MIST (Metabolism-Informed Smoking Treatment)
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. The MIST intervention used NMR to select medication (Fast Metabolizers NMR≥0.31-varenicline; Slow Metabolizers NMR \<0.31-NRT).
Guideline-Based Care
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. Medication was selected by shared decision making. Guideline-based care participants were not informed of NMR results.
Overall Study
Death
16
17
Overall Study
Withdrawal by Subject
7
2

Baseline Characteristics

Metabolism Informed Smoking Treatment: The MIST RCT

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
MIST (Metabolism-Informed Smoking Treatment)
n=294 Participants
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. The MIST intervention used NMR to select medication (Fast Metabolizers NMR≥0.31-varenicline; Slow Metabolizers NMR \<0.31-NRT).
Guideline-Based Care
n=307 Participants
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. Medication was selected by shared decision making. Guideline-based care participants were not informed of NMR results.
Total
n=601 Participants
Total of all reporting groups
Age, Categorical
<=18 years
0 Participants
n=37 Participants
0 Participants
n=37 Participants
0 Participants
n=74 Participants
Age, Categorical
Between 18 and 65 years
231 Participants
n=37 Participants
220 Participants
n=37 Participants
451 Participants
n=74 Participants
Age, Categorical
>=65 years
63 Participants
n=37 Participants
87 Participants
n=37 Participants
150 Participants
n=74 Participants
Age, Continuous
55.88 years
STANDARD_DEVIATION 11.60 • n=37 Participants
56.45 years
STANDARD_DEVIATION 11.53 • n=37 Participants
56.17 years
STANDARD_DEVIATION 11.56 • n=74 Participants
Sex: Female, Male
Female
127 Participants
n=37 Participants
136 Participants
n=37 Participants
263 Participants
n=74 Participants
Sex: Female, Male
Male
167 Participants
n=37 Participants
171 Participants
n=37 Participants
338 Participants
n=74 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
5 Participants
n=37 Participants
4 Participants
n=37 Participants
9 Participants
n=74 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
287 Participants
n=37 Participants
300 Participants
n=37 Participants
587 Participants
n=74 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
2 Participants
n=37 Participants
3 Participants
n=37 Participants
5 Participants
n=74 Participants
Race/Ethnicity, Customized
American Indian or Alaska Native
1 Participants
n=37 Participants
1 Participants
n=37 Participants
2 Participants
n=74 Participants
Race/Ethnicity, Customized
Asian
2 Participants
n=37 Participants
0 Participants
n=37 Participants
2 Participants
n=74 Participants
Race/Ethnicity, Customized
Native Hawaiian or Other Pacific Islander
2 Participants
n=37 Participants
0 Participants
n=37 Participants
2 Participants
n=74 Participants
Race/Ethnicity, Customized
Black or African American
58 Participants
n=37 Participants
66 Participants
n=37 Participants
124 Participants
n=74 Participants
Race/Ethnicity, Customized
White
224 Participants
n=37 Participants
239 Participants
n=37 Participants
463 Participants
n=74 Participants
Race/Ethnicity, Customized
Unknown or Not Reported
7 Participants
n=37 Participants
1 Participants
n=37 Participants
8 Participants
n=74 Participants
Region of Enrollment
United States
294 participants
n=37 Participants
307 participants
n=37 Participants
601 participants
n=74 Participants

PRIMARY outcome

Timeframe: 6 months

Population: Randomized participants were analyzed. Participants with missing self-report or biochemical verification data were assumed to be smoking (missing=smoking).

Outcome measures

Outcome measures
Measure
MIST (Metabolism-Informed Smoking Treatment)
n=294 Participants
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. The MIST intervention used NMR to select medication (Fast Metabolizers NMR≥0.31-varenicline; Slow Metabolizers NMR \<0.31-NRT).
Guideline-Based Care
n=307 Participants
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. Medication was selected by shared decision making. Guideline-based care participants were not informed of NMR results.
Biochemically-validated Past 7-day Point Prevalence Tobacco Abstinence
54 Participants
49 Participants

SECONDARY outcome

Timeframe: 12 months

Population: Randomized participants were analyzed. Participants with missing self-report or biochemical verification data were assumed to be smoking (missing=smoking).

Outcome measures

Outcome measures
Measure
MIST (Metabolism-Informed Smoking Treatment)
n=294 Participants
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. The MIST intervention used NMR to select medication (Fast Metabolizers NMR≥0.31-varenicline; Slow Metabolizers NMR \<0.31-NRT).
Guideline-Based Care
n=307 Participants
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. Medication was selected by shared decision making. Guideline-based care participants were not informed of NMR results.
Biochemically-validated Past 7-day Point Prevalence Tobacco Abstinence
49 Participants
51 Participants

SECONDARY outcome

Timeframe: 1, 3 months

Participants taking any stop-smoking medications in past 7 days at 1 AND/OR 3 month surveys, also includes those who reported completing their course of medication at 3 months.

Outcome measures

Outcome measures
Measure
MIST (Metabolism-Informed Smoking Treatment)
n=294 Participants
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. The MIST intervention used NMR to select medication (Fast Metabolizers NMR≥0.31-varenicline; Slow Metabolizers NMR \<0.31-NRT).
Guideline-Based Care
n=307 Participants
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. Medication was selected by shared decision making. Guideline-based care participants were not informed of NMR results.
Self-reported Medication Adherence Over the Past 7 Days
234 Participants
232 Participants

SECONDARY outcome

Timeframe: Up to 12 months after hospital discharge

Population: Of note, 395 participants were missing for this measure due to report of not having an office visit and/or non-completion of all follow-up surveys.

Randomized participants who reported having an office visit with PCP or regular healthcare provider and reported receiving a medication recommendation or prescription (since study enrollment; 1, 3, 6, or 12 months). Some participants may have reported receiving more than 1 prescription over the course of the 12 months.

Outcome measures

Outcome measures
Measure
MIST (Metabolism-Informed Smoking Treatment)
n=294 Participants
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. The MIST intervention used NMR to select medication (Fast Metabolizers NMR≥0.31-varenicline; Slow Metabolizers NMR \<0.31-NRT).
Guideline-Based Care
n=307 Participants
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. Medication was selected by shared decision making. Guideline-based care participants were not informed of NMR results.
Self-reported Receipt of Prescription for Smoking Cessation Medication Subsequent to the Initial Study Medication Prescription
70 Participants
74 Participants

Adverse Events

MIST (Metabolism-Informed Smoking Treatment)

Serious events: 140 serious events
Other events: 84 other events
Deaths: 16 deaths

Guideline-Based Care

Serious events: 131 serious events
Other events: 90 other events
Deaths: 17 deaths

Serious adverse events

Serious adverse events
Measure
MIST (Metabolism-Informed Smoking Treatment)
n=294 participants at risk
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. The MIST intervention used NMR to select medication (Fast Metabolizers NMR≥0.31-varenicline; Slow Metabolizers NMR \<0.31-NRT).
Guideline-Based Care
n=307 participants at risk
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. Medication was selected by shared decision making. Guideline-based care participants were not informed of NMR results.
Psychiatric disorders
Anxiety (includes nervousness and panic attacks)
0.68%
2/294 • Number of events 2 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
2.0%
6/307 • Number of events 7 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Psychiatric disorders
Depressed mood
0.00%
0/294 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
2.3%
7/307 • Number of events 7 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Cardiac disorders
Emergency Medical Visit
3.1%
9/294 • Number of events 11 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
2.9%
9/307 • Number of events 10 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Surgical and medical procedures
Emergency Medical Visit
24.8%
73/294 • Number of events 159 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
24.8%
76/307 • Number of events 175 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Product Issues
Medication Side Effects
1.0%
3/294 • Number of events 3 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
0.00%
0/307 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Cardiac disorders
Scheduled Medical Procedure
1.7%
5/294 • Number of events 5 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
0.98%
3/307 • Number of events 3 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Investigations
Scheduled Medical Procedure
0.34%
1/294 • Number of events 1 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
0.00%
0/307 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Renal and urinary disorders
Hospital Admission
1.4%
4/294 • Number of events 8 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
2.6%
8/307 • Number of events 8 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Surgical and medical procedures
Scheduled Medical Procedure
8.8%
26/294 • Number of events 34 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
10.1%
31/307 • Number of events 36 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Blood and lymphatic system disorders
Hospital Admission
0.68%
2/294 • Number of events 2 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
0.00%
0/307 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Cardiac disorders
Hospital Admission
5.4%
16/294 • Number of events 18 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
4.2%
13/307 • Number of events 15 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Endocrine disorders
Hospital Admission
0.00%
0/294 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
0.33%
1/307 • Number of events 1 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Gastrointestinal disorders
Hospital Admission
0.68%
2/294 • Number of events 2 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
0.00%
0/307 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
General disorders
Hospital Admission
0.00%
0/294 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
0.65%
2/307 • Number of events 2 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Hepatobiliary disorders
Hospital Admission
0.00%
0/294 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
0.65%
2/307 • Number of events 2 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Infections and infestations
Hospital Admission
2.4%
7/294 • Number of events 8 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
1.6%
5/307 • Number of events 5 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Injury, poisoning and procedural complications
Hospital Admission
0.68%
2/294 • Number of events 2 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
0.65%
2/307 • Number of events 2 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Investigations
Hospital Admission
0.00%
0/294 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
0.33%
1/307 • Number of events 1 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Hospital Admission
0.68%
2/294 • Number of events 2 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
0.00%
0/307 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Respiratory, thoracic and mediastinal disorders
Hospital Admission
1.0%
3/294 • Number of events 3 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
0.33%
1/307 • Number of events 1 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Skin and subcutaneous tissue disorders
Hospital Admission
0.00%
0/294 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
0.33%
1/307 • Number of events 1 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Surgical and medical procedures
Hospital Admission
8.8%
26/294 • Number of events 28 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
5.5%
17/307 • Number of events 19 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.

Other adverse events

Other adverse events
Measure
MIST (Metabolism-Informed Smoking Treatment)
n=294 participants at risk
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. The MIST intervention used NMR to select medication (Fast Metabolizers NMR≥0.31-varenicline; Slow Metabolizers NMR \<0.31-NRT).
Guideline-Based Care
n=307 participants at risk
All patients had a tobacco treatment consult and NMR measured by LC-tandem mass spectroscopy before randomization; all received 3 months of medication (varenicline or combination nicotine replacement therapy (NRT)) and access to tobacco counseling. Medication was selected by shared decision making. Guideline-based care participants were not informed of NMR results.
General disorders
Fatigue
6.5%
19/294 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
9.8%
30/307 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
General disorders
Insomnia
10.9%
32/294 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
9.4%
29/307 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
General disorders
Agitation and/or irritability
4.1%
12/294 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
5.9%
18/307 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Psychiatric disorders
Anxiety (includes nervousness and panic attacks)
5.1%
15/294 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
6.8%
21/307 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
General disorders
Restlessness
5.1%
15/294 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
7.2%
22/307 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
Nervous system disorders
Headaches
4.8%
14/294 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.
5.2%
16/307 • 12 months
Other (non-serious) AEs are restricted to those that participants initially self-reported as "Severe" on follow-up surveys and were determined to be non-serious by PI review.

Additional Information

Dr. Hilary Tindle

Vanderbilt University Medical Center

Phone: (615) 875-9726

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place