Baltimore — Utilizing a nicotine patch or bupropion together with a nicotine lozenge was the most effective of five therapies tested for promoting smoking abstinence and avoiding a lapse or relapse into smoking behaviors, according to a prospective study of 1,504 smokers.
All five therapies were “significantly better than placebo in promoting initial abstinence” from cigarette smoking, Sandra Japuntich, Ph.D., reported at the meeting.
The therapies also were effective at preventing relapse, said Dr. Japuntich, a postdoctoral fellow at Massachusetts General Hospital's Mongan Institute for Health Policy, Boston.
The study was important because it examined the effects of each therapy closer to the smokers' targeted quit dates than previous studies have done, Dr. Japuntich said.
The placebo-controlled trial sought to identify the effects on milestones of smoking cessation of five pharmacologic therapies: nicotine lozenge, nicotine patch, bupropion, bupropion with a nicotine lozenge, and nicotine patch with a nicotine lozenge.
The milestones were one period of 24-hour abstinence within 2 weeks of a target quit date, lapsing with at least one cigarette, and relapsing into regular smoking for at least 7 consecutive days.
A total of 70% of smokers on placebo initially abstained, compared with 92% of those using a nicotine patch with a nicotine lozenge, 86% on bupropion with a lozenge, 81% on bupropiona alone, 81% on a lozenge alone, and 88% on a nicotine patch alone.
Among the smokers who initially abstained, 83% on placebo lapsed, compared with 70% of smokers who used a nicotine patch with a lozenge, 71% on bupropion with a lozenge, 74% on bupropion alone, 73% on a lozenge alone, and 76% on a nicotine patch alone.
Of the smokers who relapsed, 69% on placebo relapsed, compared with 61% using a nicotine patch, 64% on bupropion with a lozenge, 63% on bupropion, 62% on a lozenge, and 61% on a patch with a lozenge.
The study's method provided understanding into the “more precise timing about when medications have effects,” Dr. Japuntich said. “That's important, because it informs treatment.
“According to our study, the strongest treatment effects are happening in the first week or two,” she said. “We should know whether medication is working [by then]. If you get past the first week or two on medication and you haven't lapsed, then the medication is working.”
On the other hand, for those who do not stay abstinent, “it could be that lapsing and relapsing is an indication that the medication isn't working, and that the patients might need to try something else,” she said.
Disclosures: Dr. Japuntich had no conflicts of interest to report. One of her coinvestigators, Timothy B. Baker, Ph.D., has served on research projects sponsored by pharmaceutical companies including Pfizer, Glaxo Wellcome, Sanofi, and Nabi Pharmaceuticals.