Triple combination therapy for medically ill smokers

Today sees the publication of a new study by Dr Michael Steinberg and colleagues at the University of Medicine and Dentistry of New Jersey, examining the effect of more intensive smoking cessation treatment in smokers with pre-existing medical conditions. This randomized trial compared those treated with 9 brief face-to-face sessions (from assessment to 6 month follow-up) and either standard 10-week nicotine patch treatment, or a combination of nicotine patch, plus nicotine inhaler plus bupropion, for up to 6 months.

Participants in the triple combination condition were advised to keep using the full dose of each medicine until they had gone 14 consecutive days with no withdrawal symptoms, cravings or near lapses. Once they reached that point, they were advised to gradually reduce the patch dose (over 4 weeks) then bupropion (over 2 weeks), then inhaler, so long as they felt comfortable.

The study found that of patients treated with standard patch, 19% were not smoking at 6 months, compared with 35% of those treated with the extended duration triple combination pharmacotherapy. There were more reports of insomnia and anxiety among those treated with the triple combination, but a similar small proportion (6%) of both groups dropped out of the trial due to perceived adverse effects of the medications.

This is the first trial of this triple combination therapy, and the results are broadly consistent with other studies comparing standard nicotine patch mono-therapy with a combination of medicines including the patch. It is now clear that extended combination pharmacotherapy helps more smokers quit, and remain quit, and that serious adverse events are rare.

This link will take you to the abstract at Annals of Internal Medicine, where the study was published.
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About the Author

MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.