Nicotine Patch Helps More Quitters Succeed When Worn LongerEllen Gibson
Cigarette smokers trying to quit who wear a nicotine patch for six months, rather than the standard two, may stay away from smoking longer, U.S. scientists said.
Researchers at the University of Pennsylvania School of Medicine found that 32 percent of smokers who wore the patch for 24 weeks were smoke-free, compared with 20 percent of those who used it for 8 weeks, according to a report in tomorrow's Annals of Internal Medicine. Participants used GlaxoSmithKline Plc's Nicoderm CQ. Novartis AG makes a competing product.
Smoking cigarettes increases the risk for lung cancer, heart attack, stroke and high blood pressure, according to the National Institutes of Health, and adults who smoke die 14 years earlier on average than nonsmokers. Those who puff may become addicted to nicotine, and quitters often undergo withdrawal and have cravings that persist long term.
"Nicotine addiction is not an acute condition that can be treated in a couple of months," said study author Robert Schnoll, an associate professor of psychology at Penn, in a Jan. 29 phone interview. "It's a chronic condition that needs extended therapy and we hope this research will encourage doctors to keep their patients on the patch longer."
Glaxo's NicoDerm CQ and Novartis's Habitrol are patches that supply the body and brain with a steady stream of nicotine absorbed through the skin. Current guidelines recommend using the patches for 8 weeks, the study's authors said. The nicotine helps to prevent withdrawal symptoms in people who stop smoking, according to the Bethesda, Maryland-based NIH.
The study was conducted at Penn's Transdisciplinary Tobacco Use Research Center in Philadelphia in people who smoked at least half a pack a day. About half of the 568 participants received active nicotine patches for 24 weeks. The rest had eight weeks of nicotine replacement followed by 16 weeks of placebo patches. All were given behavioral counseling.
At the end of six months, 89 people in the treatment group were smoke-free for seven days, compared with 58 people in the placebo group, the researchers said. At the one-year mark there was no difference between the two groups, with both having a quit rate of about 14 percent.
That statistic reinforces the idea that nicotine dependence should be treated more like opioid addiction, Schnoll said, where users are sometimes given methadone, a detoxification medication, for years.
No Cold Turkey
The American Lung Association in Washington doesn't recommend that smokers quit "cold turkey," without the aid of a prescription or over-the-counter treatment, said Norman Edelman, the organization's chief medical officer, in a Jan. 29 phone interview.
Nicotine supplements also come in the form of gum, lozenges, nasal sprays, and inhalers, according to the NIH. Other treatment options are Chantix, a drug from New York-based Pfizer Inc. that works on the brain's nicotine receptors, and Glaxo's Zyban, which is available in generic form under the name buproprion.
The two main barriers to keeping patients on the nicotine patch longer are side effects and costs, Schnoll said. Common side effects of the patch include skin redness, headache, nausea, and sleep problems. The researchers found no significant difference in the intensity of side effects between the treatment and placebo groups after the eighth week, according to the report.
Safer Than Smoking
"We don't know, longer term, what effect keeping people on the patch would have," said Schnoll. "But nicotine replacement therapy is definitely safer than tobacco use."
The additional cost per quitter was about $2,482 for the 24-week treatment regimen, the research paper said. Only 8.6 percent of health insurers cover the full cost of the patches, and only 33 states subsidize them for Medicaid patients, the study's authors said.
"If you do the arithmetic," said the lung association's Edelman, "you'll find that if you live in New York City and you smoke a pack a day, you're already spending about $300 a month."
The study was funded by a grant from the National Cancer Institute and the National Institute on Drug Abuse. The study's senior author, Caryn Lerman, has served as a consultant for GlaxoSmithKline.