- BMJ Group, Tuesday 3 November 2009 00.00 GMT
Combining a nicotine patch with an 'as you need it' nicotine lozenge or gum could be the best way to help smokers give up the habit, a new study has found.
What do we know already?
Quitting smoking isn't easy. Nicotine is an addictive substance and many people find it very hard to stop smoking, even when they really want to.
There are a host of products and services promising to make it easier. These include nicotine patches, which slowly release nicotine into the bloodstream, and nicotine gum, lozenges, and inhalers which provide a 'hit' of nicotine when you get a craving. In addition, the medicines bupropion (brand name Zyban) and varenicline (Champix) work on your brain chemistry to reduce cravings for nicotine.
But how do you know which treatments work best? Previous research has compared a product or pill with a placebo (a dummy treatment) rather than other smoking cessation products. So, we can say for sure that they work better than the dummy treatment, but not whether one product works better than another. That's partly because much of the existing research has been done by the drug or product manufacturer. No-one wants to run a study where their rival's product may come out better than their own.
Now, scientists have done a study looking at five different ways to quit smoking, including different types of nicotine replacement therapy products, and the drug bupropion (brand name Zyban). All the treatments were compared with a placebo version (i.e., placebo pill, patch, or lozenge) and with each other.
What does the new study say?
The combination of wearing a nicotine patch and sucking a nicotine lozenge as needed seemed to work best. By the end of six months, 4 in 10 people who used the combination of a patch and a lozenge were still smoke free. This compared with 2 in 10 people who'd taken a placebo, and about 3 in 10 who'd used the other treatments. However, the difference between the patch plus the lozenge and the other treatments was fairly small.
The other treatments assessed were the nicotine patch alone, the nicotine lozenge alone, bupropion alone, and bupropion with the nicotine lozenge. The study didn't look at nicotine gum, inhalers or sprays, or at varenicline (which wasn't licensed at the time the study started).
How reliable are the findings?
This was a good-sized (more than 1000 people) randomised controlled trial. That's the best way of testing which treatment works best. So the results should be pretty reliable. There's a risk of getting a chance finding when you compare lots of different treatments, but the researchers took account of this when they looked at the figures. They applied a strict statistical test which found that the patch plus the lozenge worked best compared with placebo.
Where does the study come from?
The study was done by researchers in Wisconsin, USA. It was published in the Archives of General Psychiatry journal. The study was funded by grants from US government research institutes, but the drugs in the study were provided free by the manufacturer GlaxoSmithKline.
What does this mean for me?
The good news is that all of the treatments worked to help people stop smoking. The patch plus lozenge combination came out particularly well. The researchers think it may be important to have continuous 'background' treatment (for example, with the patch) and a treatment to turn to when you get cravings, or when you're in a situation where you usually smoke.
All the people in the study did well in stopping smoking, compared with usual quit rates. Even the people who took placebo treatments were about twice as likely to quit successfully as in some other studies. This may have been because they were very motivated, or because they had intensive support to help them quit, as well as the medication. So we don't know whether the good results here would be as good elsewhere.
All smoking cessation treatments can have side effects. Ask your pharmacist or GP which treatments are likely to be suitable for you. Not everyone can safely take all the smoking cessation treatments available.
What should I do now?
If you want to give up smoking, speak to your GP surgery. They'll be delighted to help you quit. Alternatively, call the NHS Smoking Helpline on 0800 022 4332 to find out about stop smoking services in your area.
From:
Piper ME, Smith SS, Schlam TR, et al. A Randomized Placebo-Controlled Clinical Trial of 5 Smoking Cessation Pharmacotherapies. Archives of General Psychiatry. 2009;66(11):1253-1262.
© BMJ Publishing Group Limited ("BMJ Group") 2009