Researchers studied 568 adult smokers who smoked 10 or more cigarettes per day for at least the past year. At the end of the 24-week study, smokers who used a nicotine patch throughout the whole trial were about two times as likely to have been successful in their quitting attempts than those who received a placebo patch after the eighth week of the study: 31.6 percent of extended therapy participants had not smoked in the past seven days, compared to 20.3 percent of standard therapy participants.
More than nineteen percent of participants on the extended patch regimen did not smoke at all, even a puff, during the trial, compared to 12.6 percent of those who stopped getting the active transdermal therapy after week eight. The benefits also extended to those who relapsed during the study: The smokers on extended therapy abstained from cigarettes for longer, and were more likely to stop smoking again even if they relapsed.
When the researchers followed up with participants at week 52, however, they found no difference in the main measures of smoking abstinence between those who had used the extended patch therapy (14.5 percent) and those who used the standard regimen (14.3 percent), though the extended patch users were more likely (29.1 percent vs. 21.3 percent) to have reported no periods of smoking lasting more than 7 days in a row -- during the entire year.
Though drug therapies including Zyban and Chantix produce similar results to extended patch therapy, the authors say their findings provides a cessation option to more smokers, since nicotine patches are available over the counter and can be used even by people with seizure disorders or mental health problems like depression, who are generally advised not to use those drugs. The authors estimate that the cost per quitter for extended therapy costs $2,482, which is similar to other drug-related cessation aids.
However, cost may remain a barrier to accessing proven smoking cessation tools: Just 8.6 percent of U.S. health insurers fully cover the cost of nicotine patches, and only 33 states pay for Medicaid patients to use the patch.
In addition, to buoy smokers' long-term success following extended nicotine patch therapy, the authors suggest combining cessation strategies, such as pairing extended patch use with more intensive counseling or having smokers begin using nicotine patches before their quitting attempt begins.
"While we have documented that extended therapy is more efficacious overall than standard therapy, not everyone benefits equally," co-author Caryn Lerman says. "Therefore, our team is using genetic approaches to identify smokers who will achieve the greatest benefit from an extended or maintenance therapy approach."
Citation: Robert A. Schnoll et al., 'Effectiveness of Extended-Duration Transdermal Nicotine Therapy A Randomized Trial', Annals of Internal Medicine, February 2010, 52 (3), 144-151
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