A Randomized Placebo-Controlled Clinical Trial of 5 Smoking Cessation Pharmacotherapies

F1000 Ranking: "Must Read"

George Woody

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Faculty of 1000 

Piper ME, Smith SS, Schlam TR, Fiore MC, Jorenby DE, Fraser D, Baker TB
Arch Gen Psychiatry 2009 Nov 66(11):1253-62

Commentary from Faculty Member George Woody

This paper presents the first head-to-head comparison of five commonly used, effective smoking cessation pharmacotherapies. It shows that all are effective when compared with placebo but that the combination of nicotine patch plus nicotine lozenge was the most effective relative to placebo. These results provide important information for clinicians who are trying to choose among the available smoking cessation therapies, and call for a similar study that includes varenicline.

Among all addictive substances, cigarette smoking causes the highest morbidity and mortality rates. A number of medications have been shown to be effective in helping smokers quit, but studies have typically compared one pharmacotherapy with placebo, leaving the clinician with little evidence about which pharmacotherapy is the most effective. This study begins to fill that gap by presenting data from a head-to-head comparison of nicotine lozenge, nicotine patch, sustained-release bupropion, nicotine patch plus nicotine lozenge, bupropion plus nicotine lozenge, and placebo. The study included 1504 adults who smoked at least 10 cigarettes/day during the past 6 months and were interested in quitting, agreed to participate in the study, and had no medical or psychiatric contraindications for any of the pharmacotherapies. Pharmacotherapies were delivered for 8-12 weeks, depending on the specific medication and according to current treatment guidelines, and study participants received six smoking cessation counseling sessions. At 6 months, 22% of placebo patients had carbon dioxide-confirmed abstinence compared to 40.1% of 'patch plus lozenge' patients, with the other therapies producing abstinence rates of 31.8% to 33.4%. Placebo response rates were higher than usual, possibly due to the counseling and motivation needed to participate, and all therapies were generally well tolerated. It would be very interesting and important to conduct a similar study that includes varenicline.

Abstract

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