Smoking Cessation Trial in Recurrent Acute Pancreatitis and Chronic Pancreatitis

NCT ID: NCT07171112

Last Updated: 2025-11-10

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: PHASE2
• Total Enrollment: 45 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-11-06
• Study Completion Date: 2028-10-01

Brief Summary

The purpose of this research is to assess the effectiveness of two treatment strategies for smoking cessation in patients with acute recurrent pancreatitis or chronic pancreatitis who smoke cigarettes. All participants will receive varenicline, a commonly used medication that helps people stop smoking, at its standard dose. For those who are unable to stop smoking after 6 weeks of treatment, they will be randomly selected to either 1) increase their dose of varenicline, 2) combine varenicline with bupropion (another medication that helps with smoking cessation) or continue on the standard dose of varenicline. At the end of 12 weeks of treatment, participants will be asked if they have stopped smoking with confirmation done by measuring carbon monoxide levels in their breath.

Detailed Description

This randomized trial evaluates the safety and efficacy of varenicline-based smoking cessation treatment for patients with recurrent acute pancreatitis and chronic pancreatitis. Participants who currently smoke cigarettes and have a desire to quit smoking will be eligible to participate in this study.

Upon providing informed consent, baseline information regarding quality of life, pain, smoking history, and mental health will be collected for each participant in addition to an exhaled carbon monoxide level measurement. Participants will then be started on standard varenicline dosing for smoking cessation (1mg PO BID) for 6 weeks. Participants who continue to smoke (non-abstainers) after 6 weeks will then be randomized into 3 treatment options:

1) Increased varenicline dosing (1mg PO TID) 2) Combination of varenicline (1mg PO BID) with bupropion (150mg PO BID) or 3) Continued standard dosing of varenicline (1 mg PO BID) for an additional 6 weeks.

After 12 weeks of treatment, participants will be asked about their smoking status, have an exhaled carbon monoxide level measured and will repeat their assessments of quality of life, pain, mental health and smoking urges.

Conditions

Pancreatitis, Chronic; Pancreatitis, Acute; Recurrent Acute Pancreatitis; Smoking (Tobacco) Addiction

Keywords

Smoking cessation; chronic pancreatitis; recurrent acute pancreatitis; varenicline; bupropion

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: SEQUENTIAL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Continuation of standard varenicline dosing (1mg BID)

1\. A group that continues to take varenicline 1mg twice a day (no change)

Group Type: ACTIVE_COMPARATOR

Standard Varenicline Dosing (1 mg BID)

Intervention Type: DRUG

Varenicline PO (oral) 1mg twice daily

Combination Therapy of varenicline 1mg BID with the addition of bupropion 150 mg BID

A group assigned to the combination of standard varenicline dosing (1 mg PO BID) with bupropion (150 mg PO BID)

Group Type: EXPERIMENTAL

Standard Varenicline Dosing (1 mg BID)

Intervention Type: DRUG

Varenicline PO (oral) 1mg twice daily

Bupropion 150 mg twice daily

Intervention Type: DRUG

Bupropion 150 mg PO twice daily

Increased Varenicline Dosing (1 mg TID)

A group assigned to increased varenicline (1mg oral three times a day) dosing

Group Type: EXPERIMENTAL

Increased Varenicline Dosing (1mg TID)

Intervention Type: DRUG

Varenicline 1mg PO (oral) three times daily

Interventions

Standard Varenicline Dosing (1 mg BID)

Varenicline PO (oral) 1mg twice daily

Intervention Type: DRUG

Bupropion 150 mg twice daily

Bupropion 150 mg PO twice daily

Intervention Type: DRUG

Increased Varenicline Dosing (1mg TID)

Varenicline 1mg PO (oral) three times daily

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• Provision of signed and dated informed consent form
• Stated willingness to comply with all study procedures and availability for the duration of the study
• Male or female, aged 18 or older
• Diagnosed with either recurrent acute pancreatitis or chronic pancreatitis as defined by the American Pancreatic Association:

o Chronic Pancreatitis (any of the following): i. Moderate/marked pancreas imaging morphology (i.e. ductal and parenchymal abnormalities ii. Pancreatic calcifications iii. Histologic confirmation

o Recurrent Acute Pancreatitis: i. Two or more documented attacks of acute pancreatitis, separated by 3 months from one another, defined by at least 2 of the following 3:

1. amylase or lipase values, or both, that are greater than 3 times the upper limit of normal values

2. characteristic cross-sectional imaging

3. typically upper abdominal pain according to the revised Atlanta classification

• Currently smoking ≥ 5 cigarettes/day
• Explicitly express a desire to quit within 30 days
• Ability to take oral medication and be willing to adhere to the study intervention regimen
• Willing and able to comply with trial protocol and follow-up

Exclusion Criteria

• Age < 18 years
• Ongoing acute pancreatitis or prior episode of pancreatitis in previous 30 days
• No desire to quit smoking
• Currently undergoing smoking cessation intervention (i.e. nicotine replacement therapy, varenicline, counseling, bupropion).
• Known allergic reactions to varenicline or bupropion SR
• History of seizures
• History of an eating disorder (anorexia or bulimia)
• Closed head trauma with any loss of consciousness or amnesia in the last 5 year
• Ever history of closed head trauma with > 30 minutes of loss of consciousness or amnesia or resulting in skull fracture or subdural hematoma/brain contusion
• Ever history of alcohol withdrawal
• Ever history of chronic kidney disease (creatine clearance < 30 mL/minute)
• Liver impairment (i.e. history of cirrhosis) with aminotransferase elevation ≥ 2 times the upper limit of normal and/or alkaline phosphatase elevation ≥ 2 times the upper limit of normal.
• History of bipolar disorder or psychosis
• Ongoing or recent use (prior 14 days) of any monoamine oxidase inhibitors (isocarboxazid, phenelzine, tranylcypromine, selegiline).
• Regular use of potent CYP2B6 inhibitors (i.e. clopidogrel, ticlopidine)
• Regular use of CYP2D6 substrates with narrow therapeutic indices (e.g. flecainide, propafenone, tricyclic antidepressants such as nortriptyline, thioridazine, vinblastine)
• History of acute angle closure glaucoma
• Meet criteria for depression as assessed by the Center for Epidemiologic Studies - Depression (CES-D) with a score of 16 or higher.
• Psychiatric hospitalization within 1 year of screening
• Participants who have a score of 3 or higher on the Columbus-Suicide Severity Rating Scale (C-SSRS) at enrollment or during any of the study assessments will be excluded
• Unable to provide consent for self Incarcerated
• Pregnant females. All female patients of childbearing potential must have a negative pregnancy test and must agree to use highly effective (failure rate <1%) contraception during participation in the study.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Mayo Clinic

OTHER

Sponsor Role: lead

Responsible Party

Samuel Han

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Samuel Han, MD

Role: PRINCIPAL_INVESTIGATOR

Mayo Clinic

Locations

Mayo Clinic

Rochester, Minnesota, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Shelly Ward

Role: CONTACT

Phone: 507-538-9997

Email: Ward.Shelly1@mayo.edu

Facility Contacts

Shelly Ward

Role: primary

References

Ebbert JO, Hatsukami DK, Croghan IT, Schroeder DR, Allen SS, Hays JT, Hurt RD. Combination varenicline and bupropion SR for tobacco-dependence treatment in cigarette smokers: a randomized trial. JAMA. 2014 Jan 8;311(2):155-63. doi: 10.1001/jama.2013.283185.

Reference Type: BACKGROUND

PMID: 24399554 (View on PubMed)

Cinciripini PM, Green CE, Shete S, Minnix JA, Robinson JD, Cui Y, Kim S, Kypriotakis G, Beneventi D, Blalock JA, Versace F, Karam-Hage M. Smoking Cessation After Initial Treatment Failure With Varenicline or Nicotine Replacement: A Randomized Clinical Trial. JAMA. 2024 May 28;331(20):1722-1731. doi: 10.1001/jama.2024.4183.

Reference Type: BACKGROUND

PMID: 38696203 (View on PubMed)

Other Identifiers

25-004013

Identifier Type: -

Identifier Source: org_study_id