Long-Term Use of Nicotine Replacement | Journal Scan

Study Questions:

Is long-term use of nicotine patches associated with greater abstinence to smoking?

Methods:

This was a randomized trial, which enrolled smokers who were seeking treatment for smoking cessation. The trial was conducted from June 2009 through April 2014 in two universities. Participants had to be 18 years of age or older and smoke at least 10 cigarettes per day. Smokers received counseling (12 sessions) and were randomized to one of three groups, which varied in duration of nicotine patch treatment (1, 24, and 52 weeks). The primary outcome of interest was 7-day point prevalence abstinence, which was confirmed by carbon monoxide levels in the breath at 6 and 12 months of follow-up.

Results:

A total of 525 participants were included, of which approximately one half were African American and 18% carried a diagnosis of major depression (past or current). The mean age was 46.4 years and 50% of the participants were female. At 24 weeks, 21.7% of participants in the standard treatment arm (8 weeks) were abstinent compared to 27.2% of participants in the extended arm (24 weeks) and maintenance arm (52 weeks), which was not statistically different (p = 0.17). However, at 24 weeks, participants in the extended and maintenance arms reported higher rates of abstinence compared to the those randomized to the standard 8 weeks of treatment (odds ratio, 1.70; 95% confidence interval, 1.03-2.81; p = 0.04). Those in the extended and maintenance arms also reported longer duration of abstinence, and reported smoking fewer cigarettes if not abstinent, compared to the standard arm participants. At 52 weeks, participants in the three arms reported similar abstinence rates. Participants in the maintenance arm did report lower adherence to the nicotine patch compared to the other two arms. Treatment duration was not associated with difference in adverse effects.

Conclusions:

The investigators concluded that long-term use of nicotine patches is safe; however, improved efficacy beyond 24 weeks was not observed.

Perspective:

These data suggest that long-term use of nicotine patches is not associated with increased adverse effects, and may be helpful for some patients. However, the long-term use is not associated with greater abstinence rates.

Clinical Topics: Prevention, Smoking

Keywords: Carbon Monoxide, Counseling, Follow-Up Studies, Nicotine, Prevalence, Smoke, Smoking, Smoking Cessation, Tobacco, Tobacco Use Cessation Products, Tobacco Use Disorder, Primary Prevention


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