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Effects on abstinence of nicotine patch treatment before quitting smoking: parallel, two arm, pragmatic randomised trial

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Effects on abstinence of nicotine patch treatment before quitting smoking : parallel, two arm, pragmatic randomised trial. / Aveyard, Paul; Pokhrel, Subhash ; Coyle, Kathryn ; Coyle, Doug ; Li, Jinshuo; Parrott, Steven James.

In: BMJ, Vol. 361, 13.06.2018, p. 1-11.

Research output: Contribution to journalArticle

Harvard

Aveyard, P, Pokhrel, S, Coyle, K, Coyle, D, Li, J & Parrott, SJ 2018, 'Effects on abstinence of nicotine patch treatment before quitting smoking: parallel, two arm, pragmatic randomised trial', BMJ, vol. 361, pp. 1-11. https://doi.org/10.1136/bmj.k2164, https://doi.org/10.1136/bmj.k2164

APA

Aveyard, P., Pokhrel, S., Coyle, K., Coyle, D., Li, J., & Parrott, S. J. (2018). Effects on abstinence of nicotine patch treatment before quitting smoking: parallel, two arm, pragmatic randomised trial. BMJ, 361, 1-11. https://doi.org/10.1136/bmj.k2164, https://doi.org/10.1136/bmj.k2164

Vancouver

Aveyard P, Pokhrel S, Coyle K, Coyle D, Li J, Parrott SJ. Effects on abstinence of nicotine patch treatment before quitting smoking: parallel, two arm, pragmatic randomised trial. BMJ. 2018 Jun 13;361:1-11. https://doi.org/10.1136/bmj.k2164, https://doi.org/10.1136/bmj.k2164

Author

Aveyard, Paul ; Pokhrel, Subhash ; Coyle, Kathryn ; Coyle, Doug ; Li, Jinshuo ; Parrott, Steven James. / Effects on abstinence of nicotine patch treatment before quitting smoking : parallel, two arm, pragmatic randomised trial. In: BMJ. 2018 ; Vol. 361. pp. 1-11.

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@article{523397e4b76e43bead2cf837318ad518,
title = "Effects on abstinence of nicotine patch treatment before quitting smoking: parallel, two arm, pragmatic randomised trial",
abstract = "OBJECTIVE: To examine the effectiveness of a nicotine patch worn for four weeks before a quit attempt.DESIGN: Randomised controlled open label trial.SETTING: Primary care and smoking cessation clinics in England, 2012-15.PARTICIPANTS: 1792 adults who were daily smokers with tobacco dependence. 899 were allocated to the preloading arm and 893 to the control arm.INTERVENTIONS: Participants were randomised 1:1, using concealed randomly permuted blocks stratified by centre, to either standard smoking cessation pharmacotherapy and behavioural support or the same treatment supplemented by four weeks of 21 mg nicotine patch use before quitting: {"}preloading.{"}MAIN OUTCOME MEASURES: The primary outcome was biochemically confirmed prolonged abstinence at six months. Secondary outcomes were prolonged abstinence at four weeks and 12 months.RESULTS: Biochemically validated abstinence at six months was achieved by 157/899 (17.5{\%}) participants in the preloading arm and 129/893 (14.4{\%}) in the control arm: difference 3.0{\%} (95{\%} confidence interval -0.4{\%} to 6.4{\%}), odds ratio 1.25 (95{\%} confidence interval 0.97 to 1.62), P=0.08 in the primary analysis. There was an imbalance between arms in the frequency of varenicline use as post-cessation treatment, and planned adjustment for this gave an odds ratio for the effect of preloading of 1.34 (95{\%} confidence interval 1.03 to 1.73), P=0.03: difference 3.8{\%} (0.4{\%} to 7.2{\%}). At four weeks, the difference in prolonged abstinence unadjusted for varenicline use was odds ratio 1.21 (1.00 to 1.48), difference 4.3{\%} (0.0{\%} to 8.7{\%}), P=0.05, and adjusted for varenicline use was 1.32 (1.08 to 1.62) P=0.007. At 12 months the odds ratio was 1.28 (0.97 to 1.69), difference 2.7{\%} (-0.4{\%} to 5.8{\%}), P=0.09 unadjusted for varenicline use and after adjustment was 1.36 (1.02 to 1.80) P=0.04. 5.9{\%} of participants discontinued preloading owing to intolerance. Gastrointestinal symptoms-chiefly nausea-occurred in 4.0{\%} (2.2{\%} to 5.9{\%}) more people in the preloading arm than control arm. Eight serious adverse events occurred in the preloading arm and eight in the control arm (odds ratio 0.99, 0.36 to 2.75).CONCLUSIONS: Evidence was insufficient to confidently show that nicotine preloading increases subsequent smoking abstinence. The beneficial effect seems to have been masked by a concurrent reduction in the use of varenicline in people using nicotine preloading, and future studies should explore ways to mitigate this unintended effect.TRIAL REGISTRATION: Current Controlled Trials ISRCTN33031001.",
keywords = "Journal Article",
author = "Paul Aveyard and Subhash Pokhrel and Kathryn Coyle and Doug Coyle and Jinshuo Li and Parrott, {Steven James}",
note = "{\circledC} 2018, The Author(s).",
year = "2018",
month = "6",
day = "13",
doi = "10.1136/bmj.k2164",
language = "English",
volume = "361",
pages = "1--11",
journal = "BMJ",
issn = "0959-8138",
publisher = "BMJ Publishing Group",

}

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TY - JOUR

T1 - Effects on abstinence of nicotine patch treatment before quitting smoking

T2 - BMJ

AU - Aveyard, Paul

AU - Pokhrel, Subhash

AU - Coyle, Kathryn

AU - Coyle, Doug

AU - Li, Jinshuo

AU - Parrott, Steven James

N1 - © 2018, The Author(s).

PY - 2018/6/13

Y1 - 2018/6/13

N2 - OBJECTIVE: To examine the effectiveness of a nicotine patch worn for four weeks before a quit attempt.DESIGN: Randomised controlled open label trial.SETTING: Primary care and smoking cessation clinics in England, 2012-15.PARTICIPANTS: 1792 adults who were daily smokers with tobacco dependence. 899 were allocated to the preloading arm and 893 to the control arm.INTERVENTIONS: Participants were randomised 1:1, using concealed randomly permuted blocks stratified by centre, to either standard smoking cessation pharmacotherapy and behavioural support or the same treatment supplemented by four weeks of 21 mg nicotine patch use before quitting: "preloading."MAIN OUTCOME MEASURES: The primary outcome was biochemically confirmed prolonged abstinence at six months. Secondary outcomes were prolonged abstinence at four weeks and 12 months.RESULTS: Biochemically validated abstinence at six months was achieved by 157/899 (17.5%) participants in the preloading arm and 129/893 (14.4%) in the control arm: difference 3.0% (95% confidence interval -0.4% to 6.4%), odds ratio 1.25 (95% confidence interval 0.97 to 1.62), P=0.08 in the primary analysis. There was an imbalance between arms in the frequency of varenicline use as post-cessation treatment, and planned adjustment for this gave an odds ratio for the effect of preloading of 1.34 (95% confidence interval 1.03 to 1.73), P=0.03: difference 3.8% (0.4% to 7.2%). At four weeks, the difference in prolonged abstinence unadjusted for varenicline use was odds ratio 1.21 (1.00 to 1.48), difference 4.3% (0.0% to 8.7%), P=0.05, and adjusted for varenicline use was 1.32 (1.08 to 1.62) P=0.007. At 12 months the odds ratio was 1.28 (0.97 to 1.69), difference 2.7% (-0.4% to 5.8%), P=0.09 unadjusted for varenicline use and after adjustment was 1.36 (1.02 to 1.80) P=0.04. 5.9% of participants discontinued preloading owing to intolerance. Gastrointestinal symptoms-chiefly nausea-occurred in 4.0% (2.2% to 5.9%) more people in the preloading arm than control arm. Eight serious adverse events occurred in the preloading arm and eight in the control arm (odds ratio 0.99, 0.36 to 2.75).CONCLUSIONS: Evidence was insufficient to confidently show that nicotine preloading increases subsequent smoking abstinence. The beneficial effect seems to have been masked by a concurrent reduction in the use of varenicline in people using nicotine preloading, and future studies should explore ways to mitigate this unintended effect.TRIAL REGISTRATION: Current Controlled Trials ISRCTN33031001.

AB - OBJECTIVE: To examine the effectiveness of a nicotine patch worn for four weeks before a quit attempt.DESIGN: Randomised controlled open label trial.SETTING: Primary care and smoking cessation clinics in England, 2012-15.PARTICIPANTS: 1792 adults who were daily smokers with tobacco dependence. 899 were allocated to the preloading arm and 893 to the control arm.INTERVENTIONS: Participants were randomised 1:1, using concealed randomly permuted blocks stratified by centre, to either standard smoking cessation pharmacotherapy and behavioural support or the same treatment supplemented by four weeks of 21 mg nicotine patch use before quitting: "preloading."MAIN OUTCOME MEASURES: The primary outcome was biochemically confirmed prolonged abstinence at six months. Secondary outcomes were prolonged abstinence at four weeks and 12 months.RESULTS: Biochemically validated abstinence at six months was achieved by 157/899 (17.5%) participants in the preloading arm and 129/893 (14.4%) in the control arm: difference 3.0% (95% confidence interval -0.4% to 6.4%), odds ratio 1.25 (95% confidence interval 0.97 to 1.62), P=0.08 in the primary analysis. There was an imbalance between arms in the frequency of varenicline use as post-cessation treatment, and planned adjustment for this gave an odds ratio for the effect of preloading of 1.34 (95% confidence interval 1.03 to 1.73), P=0.03: difference 3.8% (0.4% to 7.2%). At four weeks, the difference in prolonged abstinence unadjusted for varenicline use was odds ratio 1.21 (1.00 to 1.48), difference 4.3% (0.0% to 8.7%), P=0.05, and adjusted for varenicline use was 1.32 (1.08 to 1.62) P=0.007. At 12 months the odds ratio was 1.28 (0.97 to 1.69), difference 2.7% (-0.4% to 5.8%), P=0.09 unadjusted for varenicline use and after adjustment was 1.36 (1.02 to 1.80) P=0.04. 5.9% of participants discontinued preloading owing to intolerance. Gastrointestinal symptoms-chiefly nausea-occurred in 4.0% (2.2% to 5.9%) more people in the preloading arm than control arm. Eight serious adverse events occurred in the preloading arm and eight in the control arm (odds ratio 0.99, 0.36 to 2.75).CONCLUSIONS: Evidence was insufficient to confidently show that nicotine preloading increases subsequent smoking abstinence. The beneficial effect seems to have been masked by a concurrent reduction in the use of varenicline in people using nicotine preloading, and future studies should explore ways to mitigate this unintended effect.TRIAL REGISTRATION: Current Controlled Trials ISRCTN33031001.

KW - Journal Article

U2 - 10.1136/bmj.k2164

DO - 10.1136/bmj.k2164

M3 - Article

VL - 361

SP - 1

EP - 11

JO - BMJ

JF - BMJ

SN - 0959-8138

ER -