Carpenter MJ, Jardin BF, Burris JL, Mathew AR, Schnoll RA, Rigotti NA et al. Clinical strategies to enhance the efficacy of nicotine replacement therapy for smoking cessation: a review of the literature. Drugs 73: 407-426

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA, .
Drugs (Impact Factor: 4.34). 04/2013; 73(5). DOI: 10.1007/s40265-013-0038-y
Source: PubMed


A number of smoking cessation pharmacotherapies have led to increases in quitting and thus to significant benefits to public health. Among existing medications, nicotine replacement therapy (NRT) has been available the longest, has the largest literature base in support, and is the only option for over-the-counter access. While the short-term efficacy of NRT is well documented in clinical trials, long-term abstinence rates associated with using NRT are modest, as most smokers will relapse. This literature review examines emerging clinical strategies to improve NRT efficacy. After an initial overview of NRT and its FDA-approved indications for use, we review randomized trials in which clinical delivery of NRT was manipulated and tested, in an attempt to enhance efficacy, through (1) duration of use (pre-quit and extended use), (2) amount of use (high-dose and combination NRT), (3) tailoring to specific smoker groups (genotype and phenotype), or (4) use of NRT for novel purposes (relapse prevention, temporary abstinence, cessation induction). Outcomes vary within and across topic area, and we highlight areas that offer stronger promise. Combination NRT likely represents the most promising strategy moving forward; other clinical strategies offer conflicting evidence but deserve further testing (pre-quit NRT or tailored treatment) or offer potential utility but are in need of further, direct tests. Some areas, though based on a limited set of studies, do not offer great promise (high-dose and extended treatment NRT). We conclude with a brief discussion of emergent NRT products (e.g., oral nicotine spray, among others), which may ultimately offer greater efficacy than current formulations. In order to further lower the prevalence of smoking, novel strategies designed to optimize NRT efficacy are needed.

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    • "Agonist medications for cocaine use disorder SS Negus and J Henningfield cessation to facilitate cessation) (Carpenter et al, 2013; Fiore et al, 2008; Fucito et al, 2014; Kozlowski et al, 2007). (By way of disclosure and basis for his insights, JEH provided consulting services to GlaxoSmithKline, which was also exploring such extensions of the indication.) "
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    • "Second, tell your patients that you are willing to work with them to overcome their nicotine dependence. The treatment guidelines for tobacco dependence are a good starting point to identify evidence-based options for smoking cessation,16 although you can acknowledge that current treatment approaches for nicotine dependence are only minimally effective.42 Third, explain to your patient that the safety and effectiveness of e-cigarettes are not fully understood, nor is there any evidence to suggest that e-cigarettes are safer or more effective than existing government-approved stopping smoking medications. "
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    ABSTRACT: Purpose: This study examined a cancer diagnosis, versus orthopedic surgery, as a teachable moment for recruiting smokers and treating nicotine dependence among patients' relatives. Methods: Cancer patients and, for comparison, orthopedic patients at the University of Pennsylvania Health System were approached for referrals of relatives for a smoking cessation program, which involved behavioral counseling and nicotine patches. Primary outcomes were rate of program enrollment and rate of smoking abstinence. Potential mediators of smoking cessation were explored (e.g., treatment adherence, depression, anxiety). Two hundred and thirty-four relatives (113 cancer, 121 orthopedic) were considered eligible for the cessation program and comprised the study sample. Results: Relatives of oncology patients were significantly more likely to enroll in the smoking cessation program, vs. orthopedic relatives (75 % vs. 60%; OR = 1.96, 95% CI 1.07-3.61, p = .03), but they were not significantly more likely to remain in the program (61% vs. 52%) or quit smoking (19% vs. 26%; p's > .05). Compared to orthopedic relatives, oncology relatives showed significantly lower nicotine patch adherence and significantly greater levels of negative affect and depression and anxiety symptoms during treatment (p's < .05). Further, orthopedic relatives, compared to oncology relatives, showed a greater reduction in the perceived benefits of smoking (p = .06), which was significantly associated with abstinence (p = .02). Conclusions: While a family member's cancer diagnosis may serve as a teachable moment for a smoker to enroll in a smoking cessation treatment program, high levels of psychological distress and perceptions of the benefits of smoking and low levels of treatment adherence may undermine successful abstinence among this population.
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