Varenicline (trade name Chantix and Champix) is a medication used for smoking cessation. Varenicline is also used for the treatment of dry eye disease.The most common side-effects include nausea (feeling sick), insomnia (difficulty sleeping), abnormal dreams, headache and nasopharyngitis (inflammation of the nose and throat).It is a high-affinity partial agonist for the α4β2 nicotinic acetylcholine receptor subtype (nACh) that leads to the release of the neurotransmitter dopamine in the nucleus accumbens reward center of the brain when activated, and therefore, has the capacity to reduce the feelings of craving and withdrawal caused by smoking cessation. In this respect it is similar to cytisine and different from the nicotinic antagonist bupropion and nicotine replacement therapies (NRTs) like nicotine patches and nicotine gum. It is estimated that varenicline successfully helps one of every eleven people who smoke remain abstinent from tobacco at six months. It is on the World Health Organizations List of Essential Medicines. It is available as a generic medication. Medical uses
Varenicline is used to help people stop smoking tobacco (smoking cessation). A meta-analysis found that less than 20% of people treated with varenicline remain abstinent from smoking at one year. In a 2009 meta-analysis varenicline was found to be more effective than bupropion (odds ratio 1.40) and nicotine replacement therapies (NRT) (odds ratio 1.56).A 2013 Cochrane overview and network meta-analysis concluded that varenicline is the most effective medication for tobacco cessation and that smokers were nearly three times more likely to quit tobacco use while on varenicline than with placebo treatment.
The RS score (Richter syndrome score), which is an estimate of the patients prognosis, is based on the patients performance status, LDH, platelet count, the size of the lymphoma tumors, and the number of prior therapies already received. Overall, the median survival is between five and eight months. Untreated, RS is invariably fatal. The Hodgkins lymphoma variant of Richters carries a better prognosis than the predominant diffuse large B-cell lymphoma type, but a worse prognosis than a de novo case of Hodgkins. Epidemiology
A SEER-based analysis estimated the risk of Richters transformation in Chronic Lymphocytic Leukemia (CLL) patients in the United States to be about 0.72%. The majority of transformations (85%) were Diffuse Large B-Cell Lymphoma (DLBCL), while transformation to Hodgkin occurred in 15% of cases. Most of those transformation events were nodal (74%). The most commonly involved extra-nodal sites were the GI tract (25%), skeletal system (19%), and the brain/CNS (12%). The median time from the diagnosis of CLL to the development of Richters transformation was about 4 years, with no significant difference in the time interval based on histology of the transformation event comparing DLBCL and Hodgkins. The median age at the time of Richters transformation was 66 years. References
Further reading
Tsimberidou AM, OBrien S, Khouri I, Giles FJ, Kantarjian HM, Champlin R, Wen S, Do KA, Smith SC, Lerner S, Freireich EJ, Keating MJ (May 20, 2006). "Clinical Outcomes and Prognostic Factors in Patients With Richters Syndrome Treated With Chemotherapy or Chemoimmunotherapy With or Without Stem-Cell Transplantation". Journal of Clinical Oncology. 24 (15): 2343–2351. doi:10.1200/JCO.2005.05.0187.