More Smokers Quit With Patches and Lozenges

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Study Shows Combination Treatment Yields Best Smoking-Cessation Results

By Salynn Boyles
WebMD Health News

Reviewed By Louise Chang, MD

Nov. 2, 2009 -- Smokers who want to kick the habit are more likely to succeed when they use a combination of long-acting and immediate-delivery nicotine-replacement products, a study shows.

Study participants who used nicotine patches plus nicotine lozenges were more successful than participants who used either product alone. They also had better outcomes than those who used the smoking-cessation drug Zyban or a combination of Zyban and nicotine lozenges.

Compared to smokers who received none of these treatments, smokers who combined the patch with immediate-delivery nicotine lozenges were twice as likely to be nonsmokers six months after entering the study.

The study is not the first to suggest that two types of nicotine replacement are better than one. Government researchers came to a similar conclusion in a research analysis published in 2008.

Investigator Megan E. Piper, PhD, of the University of Wisconsin Center for Tobacco Research and Intervention, says all the medical interventions evaluated in the latest study were effective.

"But the combination of the patch and lozenge along with individual counseling gave people the best chance of quitting," she says.

The Role of Counseling

Piper tells WebMD that counseling was an important component of the study.

All 1,504 smokers in the study participated in six individual counseling sessions even if they received no other medical intervention to help them quit.

The study was designed to compare the effectiveness of five smoking-cessation strategies compared to placebo: nicotine-replacement lozenges alone, nicotine patches alone, Zyban alone, patches and lozenges, and Zyban plus lozenges.

Smoking cessation success was assessed at one week, eight weeks, and six months after the quit date. In addition to asking participants if they were still smoking, the researchers measured carbon monoxide levels in their breath as an independent measure of smoking cessation.

Six months after enrolling in the study:

• 22% of the participants who received counseling, but no other active medical intervention, had stopped smoking.
• 40% of the participants who used nicotine patches and lozenges had stopped smoking.
• The success rate was similar (32% to 34%) among participants treated with patches alone, lozenges alone, Zyban alone, or Zyban plus lozenges.

The study appears in the November issue of Archives of General Psychiatry.

Zyban, an antidepressant also marketed by the drug company GlaxoSmithKline under the brand name Wellbutrin -- is one of two prescription drugs approved for smoking cessation in the U.S.

The other, marketed by Pfizer as Chantix, was not evaluated in the new study.

Quit-Smoking Hotline

Piper says smokers have more options than ever to help them free themselves of cigarettes, including a federally funded hotline that provides telephone access to a specially trained counselor.

The hotline -- 1-800-QUIT NOW (784-8669) -- connects smokers who want to quit to their own state's smoking-cessation program.

Melissa Blair, who is director of nutrition and wellness for the state of Tennessee, tells WebMD the counselors, known as Quit Coaches, offer strategies to help a smoker quit.

In many states, including Tennessee, smokers who cannot afford nicotine-replacement products or drug treatments can get them free through their local health departments.

Smokers who enroll in the state's smoking-cessation program are assigned a specific counselor. They can call their Quit Coach whenever they need to and the counselor also calls them periodically to see how they are doing.

"This is a free service and it provides the extra support many people need to be successful," Blair says.

The North American Quitline Consortium provides information on smoking-cessation services provided by individual states.

SOURCES:

Piper, M.E. Archives of General Psychiatry, November 2009; vol 66: pp 1253-1262.

Megan E. Piper, PhD, assistant professor, Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison.

Melissa Blair, MS, director, Nutrition and Wellness, Tennessee State Health Department.

News release, Archives of General Psychiatry.

Pfizer, Chantix web site.

Department of Health and Human Services: "Treating Tobacco Use and Dependence: 2008 Update."

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