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How effective is nicotine replacement therapy in helping people to stop smoking?
1Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, St Bartholomew's Hospital Medical College, London.
Objective:
To assess the efficacy of nicotine replacement therapy in helping people to stop smoking.
Design:
Analysis of the results of 28 randomised trials of nicotine 2 mg chewing gum, six trials of nicotine 4 mg chewing gum, and six trials of nicotine transdermal patch.
Subjects And Setting:
Subjects were self referred (responding to advertisements or attending anti-smoking clinics) in 20 trials and invited (general practice or hospital patients) in 20. Therapists in self referred trials were generally experienced in helping people stop smoking but not in invited trials.
Main Outcome Measure:
Efficacy was defined as difference in percentages of treated and control subjects who had stopped smoking at one year.
Results:
Efficacy was highly significant (P < 0.001) for both gum and patch. Nicotine 2 mg chewing gum had an overall efficacy of 6% (95% confidence interval 4% to 8%), greater in self referred subjects than in invited subjects (11% v 3%). Efficacy depended on the extent of dependence on nicotine as assessed by a simple questionnaire; it was 16% (7% to 25%) in "high dependence" smokers, but in "low dependence" smokers there was no significant effect. The 4 mg gum was effective in about one third of "high dependence" smokers. The efficacy of the nicotine patch (9% (6% to 13%) overall) was less strongly related to nicotine dependence, perhaps because the patch cannot deliver a bolus of nicotine to satisfy craving.
Conclusions:
Both gum and patch are effective aids to help nicotine dependent smokers who seek help in stopping. Among the most highly nicotine dependent smokers (those craving a cigarette on waking) the 4 mg gum is the most effective form of replacement therapy; it could enable one third to stop. In less highly dependent smokers the different preparations are comparable in their efficacy but the patch offers greater convenience and minimal need for instruction in its use. Overall, nicotine replacement therapy could enable about 15% of smokers who seek help in stopping smoking to give up the habit.
Insights
Nicotine replacement therapy, including gum and patches, effectively helps dependent smokers quit. The 4 mg gum is most effective for highly dependent smokers, potentially aiding one-third to quit.
Area of Science:
- Public Health
- Addiction Medicine
- Pharmacology
Background:
- Smoking remains a leading cause of preventable death worldwide.
- Nicotine dependence is a complex addiction requiring effective cessation strategies.
- Nicotine replacement therapy (NRT) is a widely used intervention to aid smoking cessation.
Purpose of the Study:
- To evaluate the effectiveness of NRT in helping individuals stop smoking.
- To compare the efficacy of different NRT formulations (gum and patch).
Main Methods:
- Systematic analysis of 28 randomized trials of 2 mg nicotine gum, 6 trials of 4 mg nicotine gum, and 6 trials of nicotine transdermal patches.
- Efficacy measured by the difference in smoking cessation rates at one year between NRT users and controls.
- Subject recruitment included self-referred individuals and those invited from general practices or hospitals.
Main Results:
- Both nicotine gum and patches demonstrated significant efficacy (P < 0.001) in smoking cessation.
- Nicotine 2 mg gum showed 6% overall efficacy, higher in self-referred (11%) versus invited (3%) subjects.
- Efficacy was strongly linked to nicotine dependence; 16% cessation in highly dependent smokers, with no significant effect in low dependence smokers.
- The 4 mg gum was effective in approximately one-third of highly dependent smokers.
- Nicotine patch efficacy (9% overall) showed less dependence on nicotine levels, possibly due to its delivery method.
Conclusions:
- NRT (gum and patch) are effective tools for nicotine-dependent smokers seeking to quit.
- For highly dependent smokers, 4 mg nicotine gum is the most effective NRT, potentially enabling one-third to stop.
- For less dependent smokers, different NRT preparations are comparable, with patches offering convenience.
- Overall, NRT can assist approximately 15% of smokers who seek help to quit smoking.
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