Using a combination of nicotine replacement therapies has been shown to be more effective than using a single treatment.
French researchers have found that treatment with a nicotine patch and inhaler gives higher cessation rates than treatment with an inhaler alone.
Dr Abraham Bohadana (INSERM Unité, Vandoeuvre-Cedex) and colleagues compared two groups of 200 smokers. The first group received a nicotine patch (15mg/16 hours) for six weeks, then a placebo patch for six weeks and the second group received a placebo patch for 12 weeks. Both groups received a nicotine inhaler to be used when required (six to 12 cartridges/day) for three months.
At six weeks, complete abstinence was seen in 60.5 per cent of the combination group and 47.5 per cent of the monotherapy group. The figures were 42 and 31 per cent, respectively, at 12 weeks, 25 and 22.5 per cent at six months and 19.5 and 14 per cent at one year.
The researchers comment that abstinence rates were consistently higher in the combination group but that the differences were only statistically significant up to week 12. They conclude that combination NRT is superior to single NRT in terms of nicotine substitution.
Other studies have examined different combinations of NRT. Dr Bohadana and colleagues pooled the results from these studies with their own results and calculated an odds ratio of 1.7 for smoking cessation at 12 months for combination therapy compared with single therapy.
Administration of nicotine in different formulations could improve short- and long-term abstinence and may be particularly useful for highly dependent smokers, they conclude. (The study is scheduled for publication in the Archives of Internal Medicine in November, 2000).
Commenting on the study, Professor Martin Jarvis (smoking cessation expert, health behaviour unit, University College London) said: "This trial provides valuable evidence for recommending combination therapy with nicotine replacement products. Unfortunately NRT products are not licensed to be used in combination with each other, although this trial and at least three other studies have proved the effectiveness of a combination therapy."
A spokesman for Pharmacia & Upjohn told The Journal on August 1 that the company had no current plans to apply for a licence for combination NRT in the UK. This was because further trials were required to prove the efficacy of combination therapy.