The first head-to-head comparison of different quit-smoking products finds that a nicotine patch combined with a nicotine lozenge had the most success.
More than other methods, including antidepressants, this combination best mimics the actual highs and lows of smoking to help smokers kick their habit, experts said.
"The study shows that, yes, one therapy came out on top, the patch and the lozenge [together]," said Dr Jonathan H. Whiteson, co-director of the Joan and Joel Smilow Cardiopulmonary Rehabilitation and Prevention Centre at NYU Langone Medical Centre in New York City.
"The reasoning behind it is that the patch supplies a steady supply of nicotine replacement, and the lozenges give a boost of nicotine which you can use when you have an extra craving. It gives people control," said Whiteson, who was not involved in the research.
"If you combine these different types of nicotine replacement you're going to get the best bang for your buck," added Megan E. Piper, lead author of the new study and an assistant professor at the Centre for Tobacco Research and Intervention at the University of Wisconsin, Madison. "But also remember that in this study people got a lot of counselling. It was that combination that resulted in a 40% quit rate [at six months out]."
How the study was done
In fact, coupling the patch with the lozenge was the only intervention that performed better than a placebo, reported the study, which appears in the November issue of the Archives of General Psychiatry.
The study adds insight to a field that's long suffered from too little research. "As each medication comes out, it is tested against a placebo," but not against other methods, Piper explained. "There just hasn't been the funding or the availability of a programme to do something like that."
This research was funded by the US National Institutes of Health. Medication was provided free by drug maker GlaxoSmithKline. Several of the study authors reported financial ties to different pharmaceutical companies.
For this study, 1 504 adults who had smoked at least half a pack a day for the past six months and wanted to quit were randomly assigned to a placebo or one of five different quit-smoking interventions: nicotine lozenge, nicotine patch, bupropion (Wellbutrin, an antidepressant), nicotine patch plus nicotine lozenge, and bupropion plus nicotine lozenge. All groups received six individual counselling sessions with a case manager.
The nicotine patch, which has been available for more than two decades, is currently the most widely used pharmacotherapy to help people quit smoking.
What the results showed
However, only the combination of the nicotine patch and the lozenge performed significantly better than placebo six months after the person smoked their last cigarette, the team found.
People taking the patch-lozenge combination were also more likely to have sworn off cigarettes after one week, and were more likely to have attained one full day without smoking, the researchers said.
The 40% (at six months) success rate reported here will decline as time goes on, Whiteson noted. He added, however, that in the smoking cessation arena, "even the 30% range is very good."
Another expert said the study raised some key concerns. "The question is, how many of them had to continue on the lozenge in order to stay off cigarettes? I always tell people not to do the lozenge alone because it mimics the very thing that smoking does, which gives you a spike. Then, when you reach a trough, you pick up a lozenge -- or cigarette," said Dr Len Horovitz, a pulmonary specialist with Lenox Hill Hospital in New York City. "Once they stopped everything, could they do without the spikes and troughs [of the lozenge], which mimics physiologically everything the cigarette is doing? Smoking is a two-pronged problem. There's nicotine dependence and a behavioural aspect to it."
Dr Elliot Wineburg, assistant clinical professor of psychiatry at Mount Sinai School of Medicine in New York City, felt the study suffered from some limitations, namely lack of individual attention to individual smokers' habits.
"The authors said that they gave the patients lozenges according to the company's [instructions]," he said. But this doesn't take into account how much people smoke or how strong their cigarettes are. "They don't even look into the amount of nicotine a person takes." – (HealthDay News, November 2009)
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