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PapersNicotine nasal spray with nicotine patch for smoking cessation: randomised trial with six year follow upCommentary: Progress on nicotine replacement therapy for smokers

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7179.285 (Published 30 January 1999) Cite this as: BMJ 1999;318:285

Footnotes

    Nicotine nasal spray with nicotine patch for smoking cessation: randomised trial with six year follow up

    1. Thorsteinn Blondal, chest physician (thorsteinn.blondal{at}hr.is)a,
    2. Larus Jon Gudmundsson, research physiotherapista,
    3. Ingileif Olafsdottir, research nursea,
    4. Gunnar Gustavsson, clinical research managerb,
    5. Ake Westin, biostatisticianb
    1. aReykjavik Health Care Centre, Baronstigur 47, 101 Reykjavik and National University Hospital, Iceland
    2. bPharmacia and Upjohn, Box 941 S-251 09 Helsingborg, Sweden
    3. Department of Psychiatry, Tobacco Research Section and National Addiction Centre, Institute of Psychiatry, London SE5 8AF
    1. Correspondence to: Dr Blondal

      Abstract

      Objective: To evaluate the efficacy of using a nicotine patch for 5 months with a nicotine nasal spray for 1 year.

      Design: Placebo controlled, double blind trial.

      Setting: Reykjavik health centre.

      Subjects: 237 smokers aged 22-66 years living in or around Reykjavik.

      Interventions: Nicotine patch for 5 months with nicotine nasal spray for 1 year (n=118) or nicotine patch with placebo spray (n=119). Treatment with patches included 15 mg of nicotine for 3 months, 10 mg for the fourth month, and 5 mg for the fifth month, whereas nicotine in the nasal spray was available for up to 1 year. Both groups received supportive treatment.

      Main outcome measure: Sustained abstinence from smoking.

      Results: The log rank test for 6 years (χ2=8.5, P=0.004) shows a significant association between abstinence from smoking and type of treatment. Sustained abstinence rates for the patch and nasal spray group and patch only group were 51% v 35% after 6 weeks (P=0.011 (χ 2), 95% confidence interval 1.17% to 3.32%), 37% v 25% after 3 months (P=0.045, 1.01% to 3.08%), 31% v 16% after 6 months (P=0.005, 1.27% to 4.50%), 27% v 11% after 12 months (P=0.001, 1.50% to 6.14%), and 16% v 9% after 6 years (P=0.077, 0.93% to 4.72%).

      Conclusions: Short and long term abstinence rates show that the combination of using a nicotine patch for 5 months with a nicotine nasal spray for 1 year is a more effective method of stopping smoking than using a patch only. The low percentage of participants using the nasal spray at 1 year, and the few relapses during the second year, suggest that it is not cost effective to use a nasal spray for longer than 7 months after stopping a patch.

      Commentary: Progress on nicotine replacement therapy for smokers

      1. John Stapleton, senior lecturer (j.stapleton{at}iop.bpmf.ac.uk)
      1. aReykjavik Health Care Centre, Baronstigur 47, 101 Reykjavik and National University Hospital, Iceland
      2. bPharmacia and Upjohn, Box 941 S-251 09 Helsingborg, Sweden
      3. Department of Psychiatry, Tobacco Research Section and National Addiction Centre, Institute of Psychiatry, London SE5 8AF
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