[Controlled randomized trials of pharmaceutic aids for smoking cessation. Results and perspectives]

In several cases tobacco smoking fulfills criteria for drug dependence. Withdrawal symptoms after smoking cessation are considered the main cause of relapses. We reviewed results of controlled clinical drug trials (testing nicotine patch, nicotine nasal spray, clonidine, buspirone and doxepin) in smoking cessation. End of treatment quit rates at 3 months with nicotine patch vary between 14% and 39% and one year quit rates between 9% et 26%. Studies with nasal nicotine spray give similar results but nicotine spray is less well tolerated than nicotine patch. The therapeutic effectiveness of nicotine patch seems to be insufficient and there is only one report of long term (> 1 year) results which should be the main goal of treatments used in smoking cessation. A therapeutic approach with psychotropic drugs founded on a better characterization of dependent smokers' psychopathology (depression, anxiety...) may be a more promising research field.