In the largest study to date comparing smoking cessation therapies, the use of the nicotine lozenge in combination with the nicotine patch provided the greatest benefit for smokers trying to quit, resulting in over a two-fold better smoking cessation outcome 6 months after quitting compared to smokers who received placebo medication. The study also showed that this combination improved initial cessation and end of treatment quit rates compared to using just one therapy. This three-year project was supported by the National Cancer Institute (NCI) and the National Institute on Drug Abuse (NIDA), both components of the National Institutes of Health (NIH). The study appears in the November 2009 in the Archives of General Psychiatry.

Many smokers have quit successfully using a variety of smoking cessation aids, but there has been little research on the relative effectiveness of these therapies. What makes this study unique is that it compared three different medications (the nicotine patch; the nicotine lozenge; and the oral medication bupropion) with placebo and each other. They also compared two different combination therapies (the lozenge plus the patch and the lozenge plus bupropion) with placebo and with a composite group combining all of the individual therapies. In addition to medication, smokers received six one-on-one counseling sessions provided by trained case managers.

More than 1,500 smokers participated in the study, with treatment lasting from eight to 12 weeks. Investigators looked at initial cessation and quit rates at several intervals, including at the end of a week, at eight weeks, and at six months.

To view the study online, go to: http://archpsyc.ama-assn.org.

Reference: Piper ME, Smith SS, Schlam TR, Fiore MC, Jorenby DE, Fraser D and Baker TB. A randomized placebo-controlled clinical trial of five smoking cessation pharmacotherapies. Archives of General Psychiatry, Vol. 66, No. 11.

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