Extended treatment with nicotine patches increases smoking cessation rates

1. Transdermal nicotine patch therapy for 24 weeks as compared to the standard 8-week regimen increased the likelihood of smoking abstinence at 24 weeks.

2. Continuation of nicotine patch therapy to 52 weeks, while safe, did not increase smoking abstinence rates significantly compared to therapy for 8 weeks or 24 weeks.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Effective smoking cessation is an important public health initiative and nicotine replacement transdermal patches are a popular medication. However, it is unclear what the most effective duration of nicotine patch treatment is to ensure higher long-term rates of smoking cessation. This randomized controlled trial examined whether long-term (52-week) patch treatment increased smoking cessation rates as compared to standard (8-week) or extended (24-week) treatment.

This study found that at 24 weeks of treatment, participants in the 52- and 24-week treatment arms had significantly higher smoking abstinence rates than those in the 8-week treatment arm. However, at 52 weeks of treatment, rates of abstinence between all treatment arms did not differ significantly. Strengths of this study include looking at a longer duration of treatment (52 weeks) and use of intention-to-treat analyses. However, limitations of the study include the lack of double-blinding and placebo control. Moreover, there was low adherence to the nicotine patch therapy regimen.

Click to read the study, published today in JAMA Internal Medicine

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In-Depth [randomized controlled trial]: This randomized controlled trial recruited smokers from Philadelphia and Chicago through media and advertisements from June 2009 to April 2014. Participants received 12 standardized smoking cessation behavioral counselling sessions and were then randomized to either the 8-week (standard), 24-week (extended) or 52-week (long-term) 21 mg nicotine patch therapies. The primary outcome was 7-day point prevalence abstinence and was confirmed with breath carbon monoxide levels at weeks 8, 24 and 52. Data analysis was performed via intention-to-treat.

In the multivariate analysis controlled for demographic and smoking-related variables, those in the extended and maintenance groups had statistically higher rates of abstinence at 24 weeks as compared to the standard 8-week treatment arm (OR 1.70, 95%CI 1.03-2.81). Participants also reported a longer duration of abstinence before relapse and smoking fewer cigarettes per day when not abstinent. However, at 52 weeks there was no significant difference in abstinence rates between the maintenance arm compared to the standard and extended arms (OR 1.17, 95%CI 0.69-1.98), or the extended arm compared to the standard arm (OR 1.33, 95%CI 0.72-2.45).

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