THE EFFECTIVENESS OF THE NICOTINE PATCH FOR SMOKING CESSATION - A METAANALYSIS

Objective-To estimate the overall efficacy and optimal use of the nico tine patch for treating tobacco dependence. Data Sources.-Nicotine pat ch efficacy studies published through September 1993, identified throu gh MEDLINE, Psychological Abstracts, and Food and Drug Administration new drug applications. Study Selection.-Double-blind, placebo-controll ed nicotine patch studies of 4 weeks or longer with random assignment of subjects, biochemical confirmation of abstinence, and subjects not selected on the basis of specific diseases (eg, coronary artery diseas e). Data Extraction.-Pooled abstinence rates and combined odds ratios (ORs) at end of treatment and 6-month follow-up were examined overall and in terms of patch type (16-hour vs 24-hour), patch treatment durat ion, dosage reduction (weaning), counseling format (individual vs grou p), and intensity of adjuvant behavioral counseling. Data Synthesis.-A cross 17 studies (n=5098 patients) meeting inclusion criteria, overall abstinence rates for the active patch were 27% (vs 13% for placebo) a t the end of treatment and 22% (vs 9% for placebo) at 6 months. The co mbined ORs for efficacy of active patch vs placebo patch were 2.6 at t he end of treatment and 3.0 at 6 months. The active patch was superior to the placebo patch regardless of patch type (16-hour vs 24-hour), p atch treatment duration, weaning, counseling format, or counseling int ensity. The 16-hour and 24-hour patches appeared equally efficacious, and extending treatment beyond 8 weeks did not appear to increase effi cacy. The pooled abstinence data showed that intensive behavioral coun seling had a reliable but modest positive impact on quit rates.Conclus ions.-The nicotine patch is an effective aid to quitting smoking acros s different patch-use strategies. Active patch subjects were more than twice as likely to quit smoking as individuals wearing a placebo patc h, and this effect was present at both high and low intensities of cou nseling. The nicotine patch is an effective smoking cessation aid and has the potential to improve public health significantly.