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Combined nicotine replacement therapy may boost smoking cessation rates

Roshini Claire Anthony
30 Oct 2019

Combining a nicotine patch plus a nicotine e-cigarette could potentially boost the likelihood of smoking cessation in adults aiming to quit smoking, according to a study from New Zealand.

“[W]hen looking at continuous abstinence from smoking, provision of patches plus a nicotine e-cigarette resulted in three to seven more smokers per 100 quitting long-term … than with patches plus a nicotine-free e-cigarette,” said the researchers.

Adult smokers who aimed to quit smoking within the following 2 weeks and with no history of e-cigarette use were randomized to receive 24-hour nicotine patches only (21 mg at one patch/day; n=125), nicotine patches plus nicotine e-cigarettes (18 mg/mL; n=500), or nicotine patches plus nicotine-free e-cigarettes (n=499) for 14 weeks. Telephone-based behavioural support was provided on a once-weekly basis for 6 weeks (median uptake, three sessions). E-cigarette use during the trial was as and when needed.

Six months after the agreed-upon quit date, a greater proportion of smokers who used both nicotine patches and nicotine e-cigarettes demonstrated continuous abstinence from smoking – determined through carbon monoxide exhalation (9 ppm) – than those who used patches plus nicotine-free e-cigarettes (7 percent vs 4 percent; relative risk [RR], 1.75; p=0.038; risk difference [RD], 2.99, 95 percent confidence interval [CI], 0.17–5.81). [Lancet Respir Med 2019;doi:10.1016/S2213-2600(19)30269-3]

Smokers who used nicotine patches plus nicotine e-cigarettes had numerically but not significantly better continuous abstinence rates at 6 months than those who only used patches (2 percent; RR, 2.92; p=0.05; RD, 4.60, 95 percent CI, 1.11–8.09), with the small sample size likely to blame for the lack of significance.

Self-reported quit rates at 1, 3, and 6 months favoured the patches plus nicotine e-cigarette group over the patches plus nicotine-free e-cigarette group (RR, 1.28; p=0.005, RR, 1.69; p<0.001, and RR, 1.68; p=0.001, respectively) or the patches-only group (RR, 2.25; p<0.001, RR, 2.25; p<0.001, and RR, 2.23; p=0.007, respectively).

The rate of study withdrawal or loss to follow up was higher in the patches-only group compared with the patches plus nicotine e-cigarette and patches plus nicotine-free e-cigarette groups (50, 32, and 33 percent, respectively).

“[It appears that] a treatment regimen that includes e-cigarettes is much more acceptable than patches alone … Treatment acceptability is crucial to widespread adoption of treatment,” said Professor Neal Benowitz from the University of California San Francisco in San Francisco, California, US, in a commentary. [Lancet Respir Med 2019;doi:10.1016/S2213-2600(19)30308-X]

Eighteen serious adverse events (AEs) occurred in the patches plus nicotine e-cigarette group (two of which were life-threatening heart attacks in one participant), 27 in the patches plus nicotine-free e-cigarette group (with one life-threatening heart attack), and four in the patches-only group. The one death in the patches plus nicotine-free e-cigarette group was due to accidental drug overdose. None of the serious AEs were considered treatment-related and serious AE incidence did not significantly differ between groups.

Given the strict tobacco control measures such as restricted advertising and low e-cigarette use in New Zealand, the findings could potentially apply “to countries with similar policy backgrounds,” said the researchers.

While individuals using both tobacco and e-cigarettes should be advised to completely switch to e-cigarettes, the lack of long-term safety data on these devices warrants cessation of use altogether, they added.  

At present, the combination of short- and long-acting nicotine replacement therapy is the “preferred first-line approach” for smoking cessation, said Benowitz. Future research should look into the comparative efficacy between dual nicotine replacement therapy with e-cigarettes over e-cigarettes alone, he suggested. 

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Most Read Articles
Pearl Toh, 31 Dec 2019
Adding the neuraminidase inhibitor oseltamivir to usual care speeds up recovery from influenza-like illness by a day compared with usual care alone, with even greater benefits seen in older, sicker patients with comorbidities, according to the ALIC4E study.
23 Dec 2019
At a Menarini-sponsored symposium held during the Asian Pacific Society Congress, renowned cardiologist Prof John Camm provided the latest evidence for chronic stable angina with or without concomitant diseases, with a special focus on the antianginal agent ranolazine and combination therapies. The event was chaired and moderated by Dr Dante Morales from the University of the Philippines College of Medicine.
Pearl Toh, 6 days ago
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Stephen Padilla, 5 days ago
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