NEW YORK (Reuters Health) – Compared with standard therapy with a nicotine patch, combination therapy with a patch, a nicotine oral inhaler, and bupropion for as long as required almost doubles quit rates at 26 weeks among smokers with medical illnesses.

That finding, from a randomized trial by a research team in New Jersey, is reported in the Annals of Internal Medicine for April 7.

“Even though persons with medical illnesses smoke at high rates, they are often not prescribed intensive smoking cessation pharmacotherapy because of concern about adverse events,” Dr. Michael B. Steinberg, at the Robert Wood Johnson Medical School in New Brunswick, and co-authors note. However, few studies have looked at interventions for these high-risk patients.

The trial included 127 smokers who expressly wanted to quit, with illnesses such as cardiovascular disease, lung disease, cancer, and diabetes but with no contraindications to treatment, including severe heart disease or seizure disorder.

Patients were randomized to a standard 10-week, tapering course of nicotine patch therapy (n = 64) or to a nicotine patch, a nicotine oral inhaler to be used as needed, and sustained-release bupropion 150 mg/d.

Abstinence rates at 26 weeks were 35% in the combination group vs 19% in the patch-alone group (adjusted odds ratio 2.57, p = 0.040). Median time to relapse was significantly longer in the combination group (65 vs 23 days, p = 0.005).

The authors note that adverse events leading to trial discontinuation was 6% in each group, and no events were directly related to comorbidities.

“The simultaneous use of nicotine medications with bupropion addresses tobacco withdrawal through different mechanisms of action,” Dr. Steinberg’s team points out, while the combination of a patch with an inhaler “to be used in response to cravings allows more individualized delivery of medication as needed.”

They add that the flexibility to extend treatment may have contributed to the results. “These findings support ad libitum duration as an advantage of a treatment regimen.”

Reference:
Ann Intern Med 2009;150:447-454.