July 8, 2014 | by Nicole White
To stop smoking, two approaches might be better than one. A new study has found that using the medication varenicline, or Chantix – along with nicotine patches – was more effective than the medicine alone in helping people quit.
The study, conducted by Stellanbosch University in Cape Town, South Africa, and published this week in the Journal of the American Medical Association, included 446 generally healthy smokers. One half used a nicotine patch, and the other half used a placebo patch; both groups began using the patches two weeks before their target quit date, and continued for an additional 12 weeks. One week before the target quite date, participants in both groups began using the drug varenicline and continued to take it for 12 weeks, tapering off in week 13.
Researchers found that patients who received the nicotine patch and varenicline were more likely to quit smoking and to have continued that abstinence at 12 weeks, 24 weeks and six months than the placebo group. In fact, at 6 months, 65.1 percent of the combination therapy group was still abstaining from smoking – confirmed by exhaled carbon monoxide measurements – versus 46.7 percent in the placebo group.
Brian Tiep, M.D., director of pulmonary rehabilitation at City of Hope, said the study not only points to a promising treatment option for smokers, but also underscores the importance of working with professionals who can create a tailored treatment plan for smokers wanting to quit the habit. Smoking is an addiction, and requires serious medical assistance, he says.
“Smoking cessation is treatment for nicotine addiction – a chronic and relapsing disease of the brain," Tiep said. "Tobacco addiction is enslaving; nicotine is a powerful stimulant bringing pleasure and reassurance within seconds of a puff."
Ending that addiction isn't easy. "Withdrawal from nicotine begins about two hours after the last cigarette and is unpleasant and uncomfortable," he added. "As with any addiction, the victim spends a lot of time and effort in securing their drug. Given this powerful dichotomy of pleasure versus discomfort, it is very difficult to quit smoking."
Tiep said the study highlights the need for smokers to keep trying to quit even if they fail the first, second or even multiple times.
"Most people try many times to quit only to relapse – typical of addiction," he said. "Efforts to quit meet with success on an average of less than 50 percent (over a year) under the most ideal of conditions such as a cessation program in a specialized hospital."
Medication can improve those odds.
"The relatively recent advent of medications designed to help patients break the additive hold by minimizing withdrawal symptoms have improved cessation substantially," Tiep said. "In addition, a number of studies have demonstrated that combining medications – particularly nicotine replacement and Zyban (bupropion) have improved the success rate over either medicine alone. The present study showed that nicotine replacement and varenicline combined work better than varenicline alone. Not all previous studies have shown this."
Concluded Tiep: "This points to the benefit of smoking-cessation professionals administering to the individual needs of each patient. Also, it is still important to include behavioral approaches, support groups and a hotline. Smoking cessation is not a casual effort – it is serious medical intervention.”
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