Tailor nicotine replacement therapy to the individual
Tailoring nicotine replacement therapy in certain smokers may increase their chances of stopping, according to US researchers. Ethnicity, weight and level of nicotine dependence could help health professionals decide whether to use transdermal or nasal spray products, they state.
In a randomised, open-label trial with a six-month follow-up, the researchers
looked at 299 people trying to give up smoking in university-based smoking
cessation research programmes. Participants received behavioural group
counselling and eight weeks of nicotine replacement therapy with either
patches or spray.
Although six-month abstinence rates for the two formulations were not
significantly different overall (12 per cent for the spray and 15 per
cent for patches), treatment outcomes for subgroups differed. Smokers
with low to moderate dependence, non-obese smokers and white smokers
achieved higher abstinence rates with transdermal nicotine, whereas highly
dependent smokers, obese smokers and smokers from non-white ethnic groups
achieved better results with nasal spray.
“Empirical data are insufficient to guide practitioners in selecting
a particular form of treatment,” the authors say. They add: “We
believe this is the first clinical trial to suggest factors for individualising
nicotine replacement therapy on the basis of pre-treatment characteristics.”
They suggest that the ability to self-administer nicotine when desired
and the effects of more rapidly delivered nicotine may be the most important
factors in facilitating abstinence
in highly dependent smokers. Obese smokers may favour the “positive
reinforcement” of the spray. African-American smokers were thought
to favour the spray because they are believed to take in more nicotine
per cigarette compared with white smokers.
The authors concede limitations in their trial and say that additional
studies are needed to validate their findings (Annals of Internal
Medicine
2004;140:426).
Britain in smoking “time warp” Britain is in a smoking “time
warp” say doctors, criticising government policy on the matter. “The
British government has conspicuously failed to take a strong lead
either nationally or within Europe in adopting regulatory strategies
on smoking and the tobacco industry that are now taken for granted
in Australia and New Zealand.” They say in 1989, for the
first time, there were more former smokers than current smokers
among Australian
adults of working age. They ask why this still has not been achieved
in Britain, despite its expertise in epidemiology on the subject
(Medical Journal of Australia 2004;180:266).
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