Pre-cessation nicotine replacement therapy: pragmatic randomized trial.

Abstract

AIMS:

To determine the effectiveness of 2 weeks' pre-cessation nicotine patches and/or gum on smoking abstinence at 6 months.

DESIGN:

Pragmatic randomized controlled trial.

SETTING:

New Zealand.

PARTICIPANTS:

Eleven hundred adult, dependent smokers who called the New Zealand Quitline between March 2006 and May 2007 for support to stop smoking were randomized to 2 weeks of nicotine patches and/or gum prior to their target quit day followed by usual care (8 weeks of patches and/or gum plus support calls from a Quitline adviser), or to usual care alone.

MEASUREMENTS:

The primary outcome was self-reported 7-day point prevalence smoking abstinence 6 months after quit day. Secondary outcomes included continuous abstinence, cotinine-verified abstinence, daily cigarette consumption, withdrawal symptoms and adverse events.

FINDINGS:

Six months after quit day 125 (22.7%) participants in the pre-cessation group and 116 (21.0%) in the control group reported 7-day point prevalence abstinence (relative risk 1.08 95% CI: 0.86, 1.35, P = 0.4, risk difference 1.7%, 95% CI: -3.2%, 6.6%). However, when pooled in a meta-analysis with other pre-cessation trials a moderate benefit of about a one-quarter increase in cessation rates was evident. There was no difference in adverse events between groups.

CONCLUSIONS:

In this, the largest pre-cessation NRT trial to date, using NRT 2 weeks before the target quit day was safe and well tolerated but offered no benefit over usual care. However, in conjunction with previous pre-cessation trials there appears to be a moderate benefit, but not as large as that seen in most smaller trials.

• Authors: Chris Bullen, Colin Howe, Ruey-Bin Lin, Michele Grigg, Murray Laugesen, Hayden McRobbie, Marewa Glover, Natalie Walker, Mark Wallace-Bell, Robyn Whittaker, Anthony Rodgers
• Journal: Addiction (Abingdon, England) (Addiction) Vol. 105 Issue 8 Pg. 1474-83 (Aug 2010) ISSN: 1360-0443 [Electronic] England
• PMID: 20528810 (Publication Type: Journal Article, Meta-Analysis, Randomized Controlled Trial)

Chemical References

• Chewing Gum
• Nicotinic Agonists
• Nicotine

Topics

• Administration, Cutaneous
• Adult
• Algorithms
• Chewing Gum
• Female
• Hotlines
• Humans
• Male
• Native Hawaiian or Other Pacific Islander
• New Zealand
• Nicotine (administration & dosage, adverse effects)
• Nicotinic Agonists (administration & dosage, adverse effects)
• Patient Acceptance of Health Care
• Smoking (ethnology)
• Smoking Cessation (ethnology, methods, statistics & numerical data)
• Smoking Prevention
• Statistics as Topic
• Substance Withdrawal Syndrome (prevention & control)
• Treatment Outcome