Combo drug therapies best for helping smokers quit

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Nearly one in five smokers offered help in kicking the habit while visiting their doctor’s office for a check-up will make a serious attempt to quit, a new study shows.

And in this “real world” setting, the most effective smoking cessation drug therapy was a combination of bupropion SR (a sustained-release form of Zyban) and nicotine lozenges, Dr. Stevens S. Smith of the University of Wisconsin School of Medicine and Public Health in Madison and colleagues found.

The researchers asked 7,128 people who smoked at least 10 cigarettes a day and were attending a routine primary care appointment if they would be interested in trying to quit. The 1,346 (18.9 percent) who agreed were randomly assigned to five different drug therapies: nicotine patch only, nicotine lozenge only, bupropion SR only, nicotine patch plus lozenge, and bupropion SR plus lozenge. The drugs were given free to the study participants, all of whom got a referral to a telephone quit line for counseling help.

Six months after starting their quit attempt, 30 percent of the study participants taking bupropion SR plus lozenges were still smoke-free, compared to 17 percent of those on bupropion SR only, 20 percent using the lozenge alone, 18 percent of those using the patch alone, and 27 percent of people using the patch and lozenges.

The bupropion SR-lozenge combination was better than all the single drug therapies, while the patch-lozenge combination was more effective than patch only or bupropion SR only.

The researchers also found that 36 percent of the people who’d used more than 90 minutes of counseling were abstinent at six months, while those who used less or didn’t get counseling at all had the same abstinence rate—around 20 percent.

“These findings provide strong support for the wide-scale implementation of this efficient primary-care based intervention model that significantly reduces barriers to patient access to evidence-based cessation treatments,” the researchers conclude.

SOURCE: Archives of Internal Medicine, Dec. 14/28, 2009.

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