A Study to Assess Changes in Cigarette Consumption During a Switch to Very Low Nicotine Cigarettes

Not Applicable

Completed

Conditions: Tobacco Use

Interventions: Other: Menthol Very Low Nicotine Cigarettes
Other: Non-Menthol Very Low Nicotine Cigarettes
Other: Subject's UB non-mentholated filtered cigarettes
Other: Subject's UB mentholated filtered cigarettes

Registration Number: NCT03571724

Lead Sponsor: 22nd Century Group, Inc.

Brief Summary: This study evaluates the impact of switching from usual brand cigarettes to very low nicotine cigarettes on cigarette consumption, smoking behavior, and biomarkers of exposure.

Detailed Description: Very low nicotine (VLN) cigarettes contain a 'non-additive' level of nicotine. This study will switch smokers from their usual brand to VLN cigarettes. Periodically during the study the investigators will collect blood and measure nicotine exposure and also other biomarkers to see what effect switching has. The participants will also use a diary to record number of cigarettes smoked. Cigarette butts will also be collected.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 142

Inclusion Criteria

Potential subjects must fulfill all of the following inclusion criteria to be eligible for participation in the study.

Is a healthy adult male or female adult smoker, 26 to 65 years of age, inclusive, at Screening.
Has been a smoker for at least 5 years prior to Screening. Brief periods of non smoking (e.g., up to 7 consecutive days due to illness, trying to quit, participation in a study where smoking was prohibited) during that time will be permitted at the discretion of the Investigator.
Reports smoking an average of 10 or more manufactured combustible cigarettes per day at Screening.
Usual brand (UB) of cigarette is a filtered king size cigarette (with an approximate length of 84 mm (± 3 mm)).
Has a positive urine cotinine (≥ 500 ng/ml) at Screening.
Has an exhaled Carbon Monoxide > 10 ppm at Screening.
If female, has a negative serum pregnancy test at Screening.
A female subject of childbearing potential must have been using one of the following forms of contraception and agree to continue using it through completion of the study:
- hormonal (e.g., oral, vaginal ring, transdermal patch, implant, or injection) consistently for at least 3 months prior to Screening;
- double barrier method (e.g., condom with spermicide, diaphragm with spermicide) consistently for at least 14 days prior to Screening;
- intrauterine device for at least 3 months prior to Screening;
- Essure® or similar nonsurgical sterilization procedure at least 6 months prior to Screening
- a partner who has been vasectomized for at least 6 months prior to Screening;
- abstinence beginning at least 14 days prior to Screening and through the End of Study.
A female subject of non childbearing potential must have undergone one of the following sterilization procedures at least 6 months prior to Screening:
- hysteroscopic sterilization;
- bilateral tubal ligation or bilateral salpingectomy;
- hysterectomy;
- bilateral oophorectomy; Or be postmenopausal with amenorrhea for at least 1 year prior to Day 1 and follicle stimulating hormone (FSH) levels consistent with postmenopausal status.
Willing to comply with the requirements of the study, including a willingness to use the test products.
Voluntary consent to participate in this study documented on the signed informed consent form (ICF).
Subject is not planning to leave the area during the course of the study.

Exclusion Criteria

Subjects may be excluded from the study if there is evidence of any of the following criteria at Screening, start of Week -1 (first clinic visit), or during the study as noted, in the opinion of the Investigator.

History or presence of clinically significant gastrointestinal, renal, hepatic, neurologic, hematologic, endocrine, oncologic, urologic, pulmonary (especially bronchospastic diseases and asthma), immunologic, psychiatric, or cardiovascular disease, or any other condition that, in the opinion of the Investigator, would jeopardize the safety of the subject or impact the validity of the study results.
Clinically significant abnormal findings on the physical examination, medical history, ECG, or clinical laboratory results, in the opinion of the Investigator.
Positive test for human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg), or hepatitis C virus (HCV).
An acute illness (e.g., upper respiratory infection, viral infection) requiring treatment with prescription medication(s) within 14 days prior to Screening or first clinic visit.
Fever (>100.5 degrees F) at Screening or first clinic visit.
Body mass index (BMI) greater than 40.0 kg/m2 or less than 18.0 kg/m2 at Screening.
History of drug or alcohol abuse or has used medical/recreational marijuana within 12 months of Screening.
Diabetes mellitus that is not controlled by diet/exercise alone, in the opinion of the Investigator.
Seated heart rate is lower than 40 bpm or higher than 99 bpm at Screening, unless deemed not clinically significant by the PI.
Seated systolic blood pressure <90 mmHg or >150 mmHg, diastolic blood pressure <40 mmHg or >95 mmHg at Screening, unless deemed not clinically significant by the PI.
Positive urine screen for drugs of abuse or alcohol at Screening or at the first clinic visit.
Female subjects who are pregnant, lactating, or intend to become pregnant from Screening through the End of Study.
Use of medications known to interact with cytochrome p450 2A6 (including, but not limited to, amiodarone, desipramine, isoniazid, ketoconazole, miconazole, phenobarbital, rifampin, tranylcypromine, methoxsalen) within 3 months prior to Screening and throughout the study.
Use of inhalers to treat any medical condition within 3 months prior to Screening and throughout the study.
Use of nicotine-containing products other than factory manufactured cigarettes [e.g., roll-your-own cigarettes, e-vapor products, bidis, snuff, nicotine inhaler, pipe, cigar, chewing tobacco, nicotine patch, nicotine spray, nicotine lozenge, or nicotine gum] within 28 days prior to Screening.
Use of any prescription smoking cessation treatments, including, but not limited to, varenicline (Chantix®) or buproprion (Zyban®) within 3 months prior to Screening.
Self-reported puffer/non-inhaler (i.e., a smoker who draws smoke from the cigarette into the mouth and throat but does not inhale).
Planning to quit smoking during the study period or postponing a quit attempt in order to participate in the study.
Plasma donation within 7 days prior to Screening or at any time during the study.
Donation of blood or blood products (with the exception of plasma as noted above), had significant blood loss, or received whole blood or a blood product transfusion within 56 days prior to Screening.
Participation in a previous clinical study for an investigational drug, device, biologic, or tobacco product within 30 days prior to Screening.
Subject or a first-degree relative (i.e., parent, sibling, child) is a current or former employee of the tobacco industry or a named party or class representative in litigation with the tobacco industry.
Subject or a first-degree relative (i.e., parent, sibling, child) is a current employee of the clinic sites.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Usual Brand (UB) mentholated filtered cigarettes	Menthol Very Low Nicotine Cigarettes	Subjects will be randomized to continue to smoke Usual Brand (UB) mentholated filtered cigarettes or to very low nicotine mentholated cigarettes
Usual Brand (UB) non-mentholated filtered cigarettes	Non-Menthol Very Low Nicotine Cigarettes	Usual Brand (UB) mentholated filtered cigarettes Usual Brand (UB) non-mentholated filtered cigarettes or to very low nicotine non-mentholated cigarettes
Usual Brand (UB) non-mentholated filtered cigarettes	Subject's UB non-mentholated filtered cigarettes	Usual Brand (UB) mentholated filtered cigarettes Usual Brand (UB) non-mentholated filtered cigarettes or to very low nicotine non-mentholated cigarettes
Usual Brand (UB) mentholated filtered cigarettes	Subject's UB mentholated filtered cigarettes	Subjects will be randomized to continue to smoke Usual Brand (UB) mentholated filtered cigarettes or to very low nicotine mentholated cigarettes

Primary Outcome Measures

Name	Time	Method
Cigarettes Per Day	Assessed daily from Week -1 to Week 6; Week -1, Week 2, and Week 6 reported	Primary objective is to measure a change in cigarette consumption behavior before, during and after switching from usual brand to to VLN cigarettes. Subjects will record their cigarette consumption daily in an electronic diary. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).All 142 randomized subjects were included in the ITT population based on product use. Out of these, 71 subjects were included in the PP Population and 71 were excluded. All excluded subjects had a ratio of \[plasma cotinine/CPD VLN\]/\[plasma cotinine/CPD baseline\] \> 0.2. It was pre-specified to exclude participants with a ratio \>0.2 as they were considered non-compliant.

Secondary Outcome Measures

Name	Time	Method
Biomarkers of Exposure - Total N-Nitrosonornicotine (NNN)	-1 week, and at 2 and 6 weeks.	Total 24 hour urine will be collected to evaluate changes in NNN before, during, and after switching to VLN cigarettes. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).
Biomarkers of Exposure - S-phenylmercapturic Acid (S-PMA)	-1 week, and at 2 and 6 weeks.	Total 24 hour urine will be collected to evaluate changes in S-PMA (benzene biomarker) before, during, and after switching to VLN cigarettes. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).
Biomarkers of Exposure - 3-hydroxypropylmercapturic Acid (3-HPMA)	-1 week, and at 2 and 6 weeks.	Total 24 hour urine will be collected to evaluate changes in 3-HPMA (acrolein biomarker) before, during, and after switching to VLN cigarettes. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).
Nicotine Pharmacokinetics - Maximum Nicotine Concentration (C-Max)	Week -1, and at 2 and 6 weeks.	Blood samples will be drawn at -5, 2, 5, 7, 10, 12, 15, 20, 30, 45, 60, 90, 120, 150 and 180 minutes relative to the start of cigarette smoking a single cigarette for determination of C-max at weeks -1, 2 and 6. The baseline data were collected for participants at Week -1, and Week -1 data are reported per pre-switch Arms/Group assignment.
Smoking Topography - Puff Duration	-1 week, and at 2 and 6 weeks.	Puff duration will be measured before, during, and after switching to VLN cigarettes. Topography will be measured during an ad libitum smoking session. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).
Smoking Topography - Puff Volume	-1 week, and at 2 and 6 weeks.	Puff volume will be measured before, during, and after switching to VLN cigarettes. Topography will be measured during an ad libitum smoking session. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).
Smoking Topography - Inter-puff Interval	-1 week, and at 2 and 6 weeks.	Inter-puff interval will be measured before, during, and after switching to VLN cigarettes. Topography will be measured during an ad libitum smoking session. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).
Subjective Effects -Fagerstrom Test for Cigarette Dependance (FTCD)	-1 week, and at 2, 4, and 6 weeks.	Subjects will answer a Fagerstrom Test for Cigarette Dependance (FTCD) questionnaire which contains six items that evaluate the quantity of cigarette consumption, the compulsion to use, and dependence.The Fagerstrom Test for Nicotine Dependence, is scored from 0 to 1 for yes/no items and 0 to 3 for multiple-choice items.The items are summed to yield a total score of 0-10. The higher the total Fagerström score, the greater the patient's physical dependence on nicotine. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).
Biomarkers of Exposure - Total 4-(Methylnitrosamino)-1-(3-pyridyl)-1 Butanol (NNAL)	-1 week, and at 2 and 6 weeks.	Total 24 hour urine will be collected to evaluate changes in NNAL (4-methylnitrosamino)-1-3-pyridyl)-1-butanone biomarker) before, during, and after switching to VLN cigarettes. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).
Biomarkers of Exposure - Total Nicotine Equivalents	-1 week, and at 2 and 6 weeks.	Total 24 hour urine will be collected to evaluate changes in total nicotine equivalents before, during, and after switching to VLN cigarettes. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).
Nicotine Pharmacokinetics - Peak Nicotine Time (T-Max)	Week -1, and at 2 and 6 weeks.	Blood samples will be drawn at -5, 2, 5, 7, 10, 12, 15, 20, 30, 45, 60, 90, 120, 150 and 180 minutes relative to the start of cigarette smoking a single cigarette for determination of T-Max at weeks -1, 2 and 6. The baseline data were collected for participants at Week -1, and Week -1 data are reported per pre-switch Arms/Group assignment.
Smoking Topography - Peak Puff Flow Rate	-1 week, and at 2 and 6 weeks.	Peak Puff Flow Rate will be measured before, during, and after switching to VLN cigarettes. Topography will be measured during an ad libitum smoking session. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).
Biomarkers of Exposure - Carboxyhemoglobin (COHb)	Week -1, and at 2 and 6 weeks.	Blood will be drawn to evaluate COHb before, during, and after switching to VLN cigarettes. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).
Biomarkers of Exposure -Cotinine	Week -1, and at 2 and 6 weeks.	Blood will be drawn to evaluate cotinine levels before, during, and after switching to VLN cigarettes. The baseline data were collected for participants at Week -1, and Week -1 data are reported per pre-switch Arms/Group assignment.
Smoking Topography - Average Flow Rate	-1 week, and at 2 and 6 weeks.	Average Puff Flow Rate will be measured before, during, and after switching to VLN cigarettes. Topography will be measured during an ad libitum smoking session. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).
Subjective Effects - Minnesota Nicotine Withdrawal Scale - Revised (MNWS-R)	-1 week, and at 2, 4, and 6 weeks.	Subjects will answer a MNWS-R questionnaire. The MNWS is considered as the briefest scale among the self-report measures of nicotine withdrawal symptoms currently available. The original MNWS was developed by Hughes and Hatsukami in 1986. It consisted of nine nicotine withdrawal symptoms including craving. The scale was modified to reflect changes made in the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for nicotine withdrawal. The total score of the scale range from 0 to 36 depending on participant's rate for the symptoms as not present (0), slight (1), mild (2), moderate (3), and severe (4). A high total score implies high nicotine addiction. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).
Biomarkers of Exposure - 1-hydroxy Pyrene(1-OHP)	-1 week, and at 2 and 6 weeks.	Total 24 hour urine will be collected to evaluate changes in 1-OHP before, during, and after switching to VLN cigarettes. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).
Nicotine Pharmacokinetics - Area Under Nicotine Concentration Curve (AUC)	Week -1, and at 2 and 6 weeks.	Blood samples will be drawn at -5, 2, 5, 7, 10, 12, 15, 20, 30, 45, 60, 90, 120, 150 and 180 minutes relative to the start of cigarette smoking a single cigarette for determination of AUC at weeks -1, 2 and 6. The baseline data were collected for participants at Week -1, and Week -1 data are reported per pre-switch Arms/Group assignment.
Subjective Effects - Perceived Health Risks	-1 week, and at 2, 4, and 6 weeks.	Subjects will answer a Perceived health risks questionnaire. The subjects indicated their perception of the risk of becoming addicted to the cigarette they were currently using on a scale from 1 to 10. Scale =1 was a very low risk of becoming addicted and Scale =10 was a very high risk of becoming addicted. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).
Subjective Effects -Brief Questionnaire of Smoking Urges (QSU-Brief)	Week -1, and at 2, 4, and 6 weeks.	Subjects will answer a Brief Questionnaire of Smoking Urges (QSU-Brief). QSU is on a scale of 1-7, with 1 being strongly disagree and 7 being strongly agree. The average score of the following is taken to determine the Factor Score 1 and Factor Score 2; Factor 1: Average of Questions 1, 3, 6, 7, and 10; Factor 2: Average of Questions 2, 4, 5, 8, and 9. The score for each factor is calculated by summing the item scores; the total score is calculated by summing all questions together. The higher the score, the greater the urge to smoke. The total score range for this questionnaire is 10-70. The baseline data were collected for participants at Week -1, and Week -1 data are reported per post-switch Arms/Group randomization (instead of pre-switch Arms/Group assignment).