Nicotine patch therapy prior to quitting smoking: a meta-analysis

AIM: To evaluate the incremental efficacy of starting nicotine patch treatment prior to quitting compared to the current regimen of starting patch treatment on the target quit day. DESIGN AND MEASUREMENTS: Meta-analysis of four eligible studies using pre-cessation patch treatment, located by database search and contacts with cessation researchers. The studies all compared starting treatment with nicotine patch prior to the target quit date to starting active treatment at the quit date, some in the context of concurrent mecamylamine treatment. The primary end-point for the analysis was continuous abstinence for at least 28 days assessed at 6 weeks following quit day; 6-month outcomes were also examined. FINDINGS: Compared to starting active patch treatment on quit day, pre-cessation treatment with nicotine patches was found to double the odds of quitting. This was true both at 6 weeks [pooled odds ratio (OR) = 1.96, 95% confidence interval (CI): 1.31-2.93] and 6 months (pooled OR = 2.17, 95% CI: 1.46-3.22) treatment outcomes. Mecamylamine co-treatment did not modify these effects. CONCLUSIONS: Across the four studies analyzed, pre-cessation patch treatment was found to produce a robust increase in quit rates compared to current regimens starting patch at quit day. Pre-cessation patch use represents a promising innovation in smoking cessation therapy with potential beneficial implications for improved public health by further increasing quitting success.     

Diagnosis and treatment of nicotine dependence with emphasis on nicotine replacement therapy. A status report.

Tobacco use is a global health care problem. Repetitive exposure to nicotine produces neuroadaptation resulting in nicotine dependence. Cigarette smoking is particularly addictive due to the repeated delivery of bolus doses of nicotine to the bloodstream. Although compulsive tobacco use is sustained by nicotine addiction, it is the toxic combustion products in tobacco smoke such as carbon monoxide and oxidant gases that adversely affect the cardiovascular system. Smoking cessation produces significant health benefits and is a very cost-effective intervention. Evidence that nicotine is the addictive component of tobacco provides the rationale for using nicotine replacement therapy to aid cessation. Nicotine replacement therapy doubles successful smoking cessation rates and evidence-based guidelines for the treatment of tobacco addiction recommend routine use of nicotine replacement therapy, particularly in heavily dependent smokers. Success rates of up to 40% can be achieved in specialist clinics. Despite early concerns regarding the safety of nicotine replacement therapy in smokers with heart disease, it is now clear that the health risks of using nicotine replacement therapy to assist such patients to stop, or significantly reduce, smoking far outweigh any treatment-related risks.     

Residential smoking therapy

OBJECTIVE: To evaluate a pilot 4-day residential smoking treatment program for smokers who had relapsed after participation in an outpatient smoking program. DESIGN: A single-arm clinical trial. Participants stayed in a supportive, smoke-free environment for 4 days during which they attended educational sessions on nutrition, exercise, and psychology. Nicotine withdrawal was treated with nicotine inhalers and patches. After discharge, participants attended monthly outpatient group sessions for 6 months. SETTING: The Durham, NC Veterans Affairs Medical Center residential unit. PARTICIPANTS: Twenty-three medical outpatient smokers. MEASUREMENTS: Seven-day point prevalence smoking abstinence was determined by self-report of zero cigarettes smoked and verified by exhaled carbon monoxide <8 parts per million. MAIN RESULTS: Participants’ mean age was 57.4 years; 100% were male; 61% were Caucasian; and 39% were African American. The mean score on the Fagerström Test for Nicotine Dependence was 7.1 (SD 2.3). Daily nicotine doses ranged from the nicotine inhaler alone to 56 mg of transdermal nicotine plus nicotine inhaler. Verified smoking abstinence on discharge (after 4 days) was 21/23 or 91.3% (95% confidence interval [95% CI], 73 to 100). At 6 months, the 7-day point abstinence rate was 6/23 or 26.1% (95% CI, 15 to 36). CONCLUSIONS: This pilot residential smoking treatment program was designed to assist smokers who relapsed after outpatient treatment. Four days of residential smoking therapy successfully relieved smoking withdrawal. At 6 months after discharge, participants maintained an abstinence rate comparable to other medical therapies for smoking.     

Use of more nicotine lozenges leads to better success in quitting smoking

AIMS AND DESIGN: The finding that smokers who used more pieces of nicotine gum achieved better treatment outcomes has been interpreted to indicate that the use of more pieces of gum leads to better treatment outcomes. However, these correlational findings are subject to at least three alternate explanations: (1) reverse causation; (2) a confounding third variable; or (3) behavioral processes. We tested these alternative explanations in secondary analyses of data from a clinical trial of nicotine lozenges. PARTICIPANTS AND METHODS: Subjects (n = 1030) who quit smoking for at least 2 weeks in a placebo-controlled trial of nicotine lozenges were studied. Lozenge use was recorded daily; outcome was assessed as carbon monoxide (CO)-verified 28-day continuous abstinence at 6 weeks. FINDINGS: To refute the reverse causation hypothesis we analyzed data on compliance during a period when subjects were abstinent: high use of active lozenge was associated with greater success; for each additional lozenge used, the odds of success increased by 10%. The third variable and behavioral processes hypotheses both predict that high lozenge use will be associated with improved outcomes even in the placebo condition. However, our analyses showed that this was not the case. Further, greater use of lozenges increased the active-placebo difference, as would be expected under a pharmacological explanation of compliance effects. CONCLUSION: The analyses rebut the alternative explanations, and suggest that use of more nicotine lozenges is causally associated with better quit rates.     

Factors associated with the efficacy of smoking cessation treatments and predictors of smoking abstinence in EAGLES

Aims

To assess (1) how far the efficacies of front‐line smoking cessation pharmacotherapies vary as a function of smoker characteristics and (2) associations between these characteristics and success of smoking cessation attempts.

Design

Prospective correlational study in the context of a double‐blind randomized trial. The outcome was regressed individually onto each covariate after adjusting for treatment, and then a forward stepwise model constructed. Treatment moderator effects of covariates were tested by treatment × covariate interactions.

Setting

Health service facilities in multiple countries.

Participants

Data came from 8120 smokers willing to make a quit attempt, randomized to varenicline, bupropion, nicotine replacement therapy (NRT) or placebo in Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) between 30 November 2011 and 13 January 2015.

Measurements

Smoker characteristics measured at baseline were country, psychiatric history, sex, age, body mass index (BMI), ethnic group, life‐time suicidal ideation/behaviour, anxiety, depression, aggression, psychotropic medication, history of alcohol/substance use disorder, age of starting smoking, cigarette dependence [Fagerström Test for Cigarette Dependence (FTCD)] and prior use of study medicines. Outcome was biochemically confirmed continuous abstinence at weeks 9–24 from start of treatment.

Findings

No statistically significant treatment × covariate interactions were found. Odds of success were associated independently positively with age [odds ratio (OR) = 1.01; 95% confidence interval (CI) = 1.00, 1.01], BMI (1.01; 95% CI = 1.00, 1.02) and age of starting smoking (1.03; 95% CI = 1.02, 1.04). Odds were associated independently negatively with US (versus non‐US) study site (0.53; 95% CI = 0.46, 0.61), black (versus white) ethnic group (0.57; 95% CI = 0.45, 0.72), mood disorder (0.85; 95% CI = 0.73, 0.99), anxiety disorder (0.71; 95% CI = 0.55, 0.90) and psychotic disorder (0.73; 95% CI = 0.50, 1.07), taking psychotropic medication (0.81; 95% CI = 0.68, 0.95), FTCD (0.89; 95% CI = 0.87, 0.92) and previous use of NRT (0.78; 95% CI = 0.67, 0.91).

Conclusions

While a range of smoker characteristics—including psychiatric history, cigarette dependence and prior use of nicotine replacement therapy (NRT)—are associated with lower cessation rates, they do not substantially influence the efficacy of varenicline, bupropion or NRT.     

A randomized trial of bupropion and/or nicotine gum as maintenance treatment for preventing smoking relapse

AIM: To investigate the efficacy of maintenance treatment with bupropion and/or nicotine gum for reducing smoking relapse. DESIGN, SETTING AND PARTICIPANTS: A 48-week study was conducted at a university-based smoking cessation clinic between February 2001 and October 2005. A total of 588 smokers received bupropion and nicotine patch in 8 weeks of open-label treatment (OLT); 289 abstainers during the last 4 weeks of OLT were randomized in double-blind placebo-controlled fashion to one of four arms for 16 weeks of maintenance treatment (MT) followed by 24 weeks of non-treatment follow-up (NTFU). INTERVENTION: Bupropion (300 mg/day) and 2 mg nicotine gum, used alone or combined, and comparable placebo pill and placebo gum. Behavioral counseling at all visits. OUTCOME: Time to relapse (TTR) from randomization. Relapse is defined as the first 7 consecutive days of smoking. Abstinence verified by carbon monoxide 相似文献   

Short-term Changes in Self-rating Depression Scale Scores after Smoking Cessation in Neurotic Patients

Objective The psychological status is a key factor in smoking continuance. However, details on short-term changes in mild depressive states after smoking cessation (SC) are still unknown. The purpose of the present study was to investigate these short-term changes. Methods A total of 989 patients who visited our SC Clinic were assessed using the Zung Self-Rating-Depression-Scale (SDS), an official instrument to measure depressive tendencies. The participants were classified into normal and neurotic groups based on their SDS scores during their initial visit; they were assessed again 2, 4, 8, and 12 weeks thereafter. Results The majority of patients in the neurotic group were women. These patients were also younger, with a higher nicotine dependence, and presented with a lower successful SC rate than the patients in the normal group. A decrease in SDS scores after starting the SC treatment was observed only in the neurotic group, especially during the first two weeks. In patients who continued to smoke, no improvement in depressive tendencies was noted in this period. Conclusion Depressive tendencies of patients with neurosis improve in the initial stages of the SC treatment (i.e., within two weeks after starting the treatment). This finding fills the mentioned knowledge gap regarding the effects of SC on mild depressive states in the short term.     

Five-year outcomes for a smoking cessation clinic

BACKGROUND AND OBJECTIVES: In Turkey, smoking cessation clinics have increased rapidly in recent years. We evaluated the demographic characteristics and the factors influencing the success of quitting among participants in a smoking cessation programme who completed a 5-year follow up. METHODS: An observational study was conducted on all smokers who attended a smoking cessation clinic between April 2000 and June 2005. RESULTS: Of the 350 participants recruited, 58% (n = 203) were male and 42% (n = 147) were female; 43.7% were university graduates. The average age of participants was 37.4 +/- 11.8 years; the average nicotine addiction level, according to the Fagerstrom nicotine dependence questionnaire, was 5.4 (+/-2.0). Seventy-eight (40.2%) of the 194 individuals who stopped smoking were women. At the end of 5 years, 34.6% of participants who attempted to quit were still successful. There was no difference between men and women in terms of their success in quitting after 5 years. Participants who received nicotine replacement therapy remained free of cigarettes 1.9 times (95% CI: 1.2-2.9) longer than those who did not. CONCLUSION: Smoking cessation programmes should use a combination of behavioural and pharmacological therapies.     

Smoking cessation therapy with varenicline

Smoking cessation is the only available intervention proven to halt progression of chronic obstructive pulmonary disease (COPD). The authors discuss the current existing treatment modalities and the role of a newly approved agent, varenicline, in promotion of smoking cessation. Varenicline is a novel agent that is a centrally acting partial nicotinic acetylcholine receptor agonist. It has both agonistic and antagonistic properties that together are believed to account for reduction of craving and withdrawal as well as blocking the rewarding effects of smoking. Its targeted mechanism of action, better efficacy and tolerability makes varenicline a useful therapeutic option for smoking cessation. In this article, we discuss presently available options for smoking cessation and review the literature on efficacy of varenicline.     

Perceived safety and efficacy of nicotine replacement therapies among US smokers and ex-smokers: relationship with use and compliance

AIM: Nicotine replacement therapy (NRT) is effective for smoking cessation, but most smokers try to quit without using it. We examined the impact of misperceptions of NRT safety and efficacy on its use. DESIGN AND PARTICIPANTS: A total of 3203 current and former US smokers completed a national mail-out survey of issues and attitudes related to smoking cessation. FINDINGS: Two-thirds (66%) of respondents either agreed that 'Stop-smoking products with nicotine are just as harmful as cigarettes' or were unsure whether the statement was true. These respondents were less likely to have used NRT in the past [30% versus 49%; odds ratio (OR) = 0.45, 95% confidence interval (CI): 0.39-0.53] and less likely to consider using NRT during future quit attempts (40% versus 53%; OR = 0.60, 95% CI = 0.51-0.71). Additionally, of the respondents who had used nicotine gum in the past 12 months (n = 407), those who had concerns about the safety of NRT reported using fewer pieces of gum per day during treatment (six versus eight pieces/day; P < 0.05), and were less likely to report that they used the gum for greater than 4 weeks (28.5% versus 46.8%; OR = 0.45, 95% CI: 0.27-0.76). A large proportion of the respondents also stated that they did not believe NRT to be efficacious. CONCLUSIONS: The findings suggest that many smokers are misinformed about the health risks of NRT and that these misperceptions impede not only the adoption of NRT but also compliance during treatment. Misperception of NRT safety is one barrier to effective use of NRT and probably reduces success in quitting.