Source: DGNews  |  Posted 2 years ago

By Walter Alexander

DUBLIN, Ireland -- May 1, 2009 -- Abstinence rates increase among highly dependent smokers when they are given a higher-dose nicotine patch, according to findings presented at the 2009 Joint Conference of the Society for Research on Nicotine and Tobacco (SRNT) and SRNT-Europe.

Jed E. Rose, PhD, Duke University Center for Nicotine & Smoking Cessation Research, Durham, North Carolina, noted that his earlier research showed continuous abstinence rates to be doubled compared with conventional treatment when a nicotine patch was given prior to the target quit-smoking date.

Among highly dependent smokers with Fagerström Test for Nicotine Dependence (FTND) scores >6, however, a 21-mg pre-cessation patch did not increase abstinence rates.

Therefore, the researchers "hypothesised that highly dependent smokers may require higher doses of nicotine replacement therapy [NRT] than 21 mg/day," Dr. Rose said on April 28.

The double-blind study included 480 smokers (mean age, 44 years) who were randomised to receive either nicotine patch treatment of 21 mg/day or 42 mg/day beginning 2 weeks prior to the target quit date. All were asked to switch to nicotine-free cigarettes to reduce nicotine overdose risks.

Change in FTND scores was measured at the quit date. Also, nicotine patch doses were gradually tapered over 10 weeks after the quit date.

Abstinence tended to be greater for highly dependent smokers receiving 42-mg nicotine patch treatment (~22% versus ~17% on 21 mg), with the opposite trend in low-dependence smokers (~28% with 21 mg/~15% with 42 mg). "Actually, the low FTND people were impeded in their abstinence, which we did not expect," Dr. Rose said.

In what he called the most exciting finding, pre-cessation FTND decreases of >=3 predicted abstinence in high-dependence (FTND >=7) smokers (~ 35% for 21 mg/~40% for 42 mg), but not in low-dependence (FTND <7) smokers (~27% for 21 mg/~17% for 42 mg).

Pre-cessation decreases in expired carbon monoxide at or above the median were predictive of abstinence in high-dependence smokers and of low cessation rates in those below the median.

"So identifying these individuals offers a wonderful opportunity for adapting treatment potentially and heading off a failed quit attempt by offering an alternative or more intensive treatment," said Dr. Rose.

The findings, Dr. Rose concluded, support that highly dependent smokers differentially benefit from higher pre-cessation NRT.

Funding for this study was provided by Philip Morris USA, Inc.

[Presentation title: 42 Mg/Day Pre-Cessation Nicotine Patch Treatment for Highly Dependent Smokers. Abstract PA2-3]