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PULMONARY
DISORDERS
Devra K. Dang, Section Advisor
Extended duration nicotine transdermal therapy may be more effective
than standard duration
Key point: According to a study recently published
in Annals of Internal Medicine, tobacco abstinence rates were
significantly higher when transdermal nicotine was used for 24 weeks
(extended duration) as opposed to 8 weeks (standard duration).
Finer points: From September 2004 to February 2008,
568 adult smokers participated in this parallel, placebo-controlled,
randomized trial comparing abstinence rates in patients using extended
duration and standard duration transdermal nicotine therapy. All
patients in the study were blinded to the randomization, as were the
research personnel, with the exception of the database manager. A total
of 287 patients were randomized to standard duration therapy with
Nicoderm CQ (GlaxoSmithKline), consisting of 21 mg for 8 weeks, then
placebo for 16 weeks; 288 patients were randomized to extended therapy
with Nicoderm CQ, consisting of 21 mg for 24 weeks. The primary outcome
measure was complete biochemically confirmed abstinence from nicotine at
24 and 52 weeks. Secondary outcome measures included continuous and
prolonged abstinence, relapse and recovery events, cost per smoker
associated with quitting, adverse events, and adherence.
At 24 weeks, extended duration therapy was associated with higher
rates of abstinence (31.6% vs. 20.3%; odds ratio [OR] 1.81 [95% CI
1.23–2.66], P = 0.002), prolonged abstinence (41.5% vs.
26.9%; OR 1.97 [1.38–2.82], P = 0.001), and continuous
abstinence (19.2% vs. 12.6%; OR 1.64 [1.04–2.60], P =
0.032) compared with standard therapy. The extended duration therapy
group also had a lower risk for relapse (hazard ratio [HR] 0.77
[0.63–0.95], P = 0.013), higher likelihood of recovery
from relapses (HR 1.47 [1.17–1.84], P = 0.001), and
slower time to relapse (HR 0.50 [0.35–0.73], P <
0.001). At 52 weeks, extended duration therapy only produced higher quit
rates for prolonged abstinence (29.1% vs. 21.3%; OR 1.55
[1.05–2.28], P = 0.027). No differences in adverse events
were noted between the two groups.
What you need to know: The investigators
acknowledged several limitations to the study. First, none of the
patients had comorbid conditions (e.g., diabetes, heart disease, or
alcohol dependence). Second, many patients in both groups stopped using
the transdermal nicotine patches within the first few weeks of starting
the study. Third, some patients did not provide complete abstinence data
at follow-up.
In a response letter published online by Annals, a nicotine
cessation educator from WhyQuit.com opposed the concept of using
nicotine to treat nicotine addicts. He noted that counseling and support
are more important components of a nicotine cessation therapy and
reported that 2 weeks of intense, abrupt cessation counseling and
support lasting for at least 12 to 14 hours are key to the success of
long-term nicotine cessation programs.
What your patients need to know: Explain to patients
that nicotine dependence is a chronic, relapsing condition that may
require extended treatment. Extended duration transdermal nicotine
therapy can benefit some patients more than standard duration therapy.
Regardless of the duration of therapy, many patients resume smoking once
they stop treatment with nicotine patches or other forms of nicotine
replacement therapy. Therefore, the benefits of extended duration
nicotine transdermal therapy appear to be short lived and may cease when
treatment is stopped. Repeated smoking cessation attempts are often
necessary and lead to greater success.
Posted by Carli Richard (crichard@aphanet.org)
March 11, 2010
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