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Published on: February 10, 2012
Nicotine nasal spray with nicotine patch for smoking cessation: randomised trial with six year follow up
T Blondal1, L J Gudmundsson, I Olafsdottir
1Reykjavik Health Care Centre, Baronstigur 47, 101 Reykjavik and National University Hospital, Iceland. blondal@hr.is
Objective:
To evaluate the efficacy of using a nicotine patch for 5 months with a nicotine nasal spray for 1 year.
Design:
Placebo controlled, double blind trial.
Setting:
Reykjavik health centre.
Subjects:
237 smokers aged 22-66 years living in or around Reykjavik.
Interventions:
Nicotine patch for 5 months with nicotine nasal spray for 1 year (n=118) or nicotine patch with placebo spray (n=119). Treatment with patches included 15 mg of nicotine for 3 months, 10 mg for the fourth month, and 5 mg for the fifth month, whereas nicotine in the nasal spray was available for up to 1 year. Both groups received supportive treatment.
Main Outcome Measure:
Sustained abstinence from smoking.
Results:
Sustained abstinence rates for the patch and nasal spray group and patch only group were 51% v 35% after 6 weeks (odds ratio 1.97, 95% confidence interval 1.17% to 3.32; P=0.011(chi2), 37% v 25% after 3 months (1.76, 1.01 to 3.08; P=0.045), 31% v 16% after 6 months (2.40, 1.27 to 4.50; P=0.005), 27% v 11% after 12 months (3.03, 1.50 to 6.14; P=0.001), and 16% v 9% after 6 years (2.09, 0.93 to 4.72; P=0.08) [corrected].
Conclusions:
Short and long term abstinence rates show that the combination of using a nicotine patch for 5 months with a nicotine nasal spray for 1 year is a more effective method of stopping smoking than using a patch only. The low percentage of participants using the nasal spray at 1 year, and the few relapses during the second year, suggest that it is not cost effective to use a nasal spray for longer than 7 months after stopping a patch.
