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Nicotine Replacement Therapy Modestly Boosts Long-term Success Rates for Smokers

First the bad news: life-long smokers die, on average, 10 years younger than people who have never smoked. Now some good news: kicking the tobacco habit at age 40, 50, or 60 can reclaim 9, 6, and 3 of those years, respectively. The effort is worth it, at any age and for any smoker.

Some more good news: there are many tools to help smokers quit. Nicotine replacement therapy (NRT) provides some of the nicotine that smokers crave, but not the harmful substances found in cigarettes, thereby easing the withdrawal symptoms that make quitting so difficult. NRT is available as a patch, gum, lozenge, and prescription inhaler or nasal spray.

The use of NRT has been touted to more than double a quitter’s success rate compared with smokers who go “cold turkey.” This figure is based on the first generation of NRT studies, which monitored volunteers up to 12 months after quitting. It is now established that relapse back to smoking continues well beyond 12 months, making the true long-term benefits of NRT unclear. To clarify this issue, researchers analyzed 12 NRT trials that lasted beyond 12 months. Their findings, in the August 2006 Tobacco Control , revealed that NRT does provide a significant, albeit modest, boost to quit rates. But since relapse was most common during the first two years after quitting, studies that ended at 12 months overestimated the long-term benefit of NRT by 30%.

About the Study

Researchers from the Institute of Social and Preventive Medicine in Switzerland identified all randomized placebo-controlled trials of NRT that lasted longer than 12 months. Twelve studies with an average follow-up of 4.3 years and a total of 4,792 participants (NRT: 2,408; placebo: 2,384) met the criteria for this meta-analysis. Three types of NRT were studied: patch (5 trials), gum (4), and nasal spray (3); each delivered about 1 mg of nicotine per hour. Participants used NRT for about three months and received counseling; the control groups only received counseling. The researchers, therefore, were able estimate the long-term effectiveness of NRT beyond the effect of counseling.

In both the treatment and placebo groups, 30% of volunteers relapsed after the 12-month point. NRT showed significant benefits in six of the 12 trials, and no benefit in the other six. But when all the data were combined and analyzed, NRT almost doubled the rate of successfully quitting beyond 12 months. However, since the rate of success was quite low, even a doubling of this rate meant success for only about 7% of the 2,408 participants receiving NRT in this meta-analysis.

Since this study is a meta-analysis, it is limited by any flaws in any of its constituent studies. For example, some trials relied on patient report of their smoking status, which could be unreliable.

How Does This Affect You?

A success rate of just 7%, even with the help of NRT, may cause you to question if the effort is worthwhile. Well, don’t; it is worthwhile. The issue is not whether or not you should quit smoking. The issue is the overall effectiveness of the prevailing approach to treatment. The trials in this meta-analysis involved a brief (3-month) one-time intervention of NRT. While NRT is helpful, a short, single intervention is apparently not enough for most smokers to overcome a long-term addiction to nicotine. In fact, most ex-smokers made 8-10 attempts before quitting for good.

The authors of this study encourage smokers and healthcare providers to treat nicotine addiction as a chronic condition that requires repeated quit attempts and ongoing follow-up and encouragement over many years. Don’t give up. You are up against a formidable foe that may require more than a trial or two of NRT. Fortunately, you have other options. Studies have shown that cognitive behavioral therapy and drug treatment with bupropion or varenicline can also help you ultimately succeed.

  • American Lung Association

    http://www.lungusa.org/

  • Centers for Disease Control and Preventio

    http://www.cdc.gov/tobacco/quit%5Fsmoking/index.htm

  • Smokefree.gov

    http://www.smokefree.gov

  • Etter J-F, Stapleton JA. Nicotine replacement therapy for long-term smoking cessation: a meta-analysis. Tobacco Control . 2006;15:280-285.

  • Smoking cessation [patient page]. JAMA . 2006;296:130.