Effects of Nicotine Patch vs Varenicline vs Combination Nicotine Replacement Therapy on Smoking Cessation

Smoking tobacco is a widespread problem throughout the world, and there have been many attempts to create pharmacotherapies for smoking cessation. A study in the Journal of the American Medical Association compared traditional nicotine replacement therapy (NRT), varenicline, and a combination nicotine replacement therapy (C-NRT) in 1086 smokers. The difference in abstinence rates between the NRT patch and the other two therapies were not considered to be significant. It was also found that those in the C-NRT and varenicline groups had significantly lower withdrawal ratings than those just using the patch. The authors mention some problems the study could have faced, including low adherence to the therapies, length of the study, and also it being an open-label study where the patients knew what they were taking.

With how common smoking is, studies revolving around smoking cessation is important. While this study may have some flaws, it illustrates that all these three therapies have an effect on motivating smokers to quit smoking. If the non-prescription patch is as effective as the other two prescription therapies, it can greatly influence some smokers’ decisions about trying to quit smoking. The patch will be a lot cheaper and accessible, thus be able to reach a larger population. A big problem the study pointed out that is also common in other smoking cessation studies is the somewhat low adherence, rates being a little below 50%. In the smokers that did adhere, results could be seen from the lower amount of cigarettes they smoked or even completely quitting. Quitting smoking will greatly improve the health of a person, and these pharmacotherapies can help one with the process.

JAMA. 2016;315(4):371-379.

Testing the Efficacy of Nicotine-Replacement Therapy Without Added Behavioral Support

In this study, Dr. Cunningham and fellow researchers devised an experiment to test the efficacy of mailing nicotine-replacement patches for smoking cessation. One of the reasons this experiment was devised was due to the prior research that indicated that nicotine-replacement therapy was very effective with behavioral support, but data on populations showed that without the behavioral support, it was as effective as not having the nicotine-replacement therapy. This study was to gather research data on the efficacy of replacement-therapy without the added behavioral support.

The study that was designed was a single-blind test with a test group and a control group. Participants were chosen by dialing random numbers and were only included if they were a current smoker that would be interested in quitting. They were also screened for any contraindications to the nicotine-replacement therapy. Of the 1,000 participants that volunteered for the trial, half would be sent the replacement patches and the other half would be control. The subjects who were chosen for the test group were given a 5-week supply of 3-stage nicotine-replacement therapy patches. The 3-stage patches decrease in concentration from stage 1 to stage 3. The subjects that were chosen for the control group would receive nothing. Follow-up calls were placed at the 8 week and 2 month mark to check on all of the participants.

At the end of the experiment, it was discovered that of the 500 that were not given any nicotine-replacement therapy, only 3% had self-reported abstinence of nicotine. This compared to the 7.6% that had self-reported abstinence of nicotine from the test group. From the data, it appears as though nicotine-replacement therapy without behavioral support is an effective method for tobacco cessation. From this information, do you think that behavioral support is more effective than nicotine-replacement therapy for tobacco cessation?

Cunningham, John A et. al. Effect of Mailing Nicotine Patches on Tobacco Cessation Among Adult Smokers. A Randomized Clinical Trial. JAMA Intern Med. Published Online February 2016.2016;176(2):184-190. doi:10.1001/jamainternmed.2015.7792.

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