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Pre-cessation nicotine treatment Jean-François ETTER Dr polit. sci, privat docent Institute de Médicine Sociale et Préventive Faculté de Médecine, Université.

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Presentation on theme: "Pre-cessation nicotine treatment Jean-François ETTER Dr polit. sci, privat docent Institute de Médicine Sociale et Préventive Faculté de Médecine, Université."— Presentation transcript:

1 Pre-cessation nicotine treatment Jean-François ETTER Dr polit. sci, privat docent Institute de Médicine Sociale et Préventive Faculté de Médecine, Université de Genève Berne, September 13, 2006

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3 Competing interests statement The Institute of Social and Preventive Medicine of the University of Geneva has received: - -trial medications (nicotine) from Pfizer, - -grants from Novartis and Pfizer to develop computer-tailored smoking cessation counseling programs, led by JFE.

4 Nicotine replacement therapy for smoking cessation   Cochrane: 105 studies, n=32’000, 6-12 months   Modest success rates (7% over placebo)   In the long term, this effect is decreased by 30%   60% of studies were funded by pharma industry   Industry-funded studies are twice as likely to find p>.05 results

5 Smoking reduction prior to quitting   Easier to quit if one smokes fewer cigarettes   Successful reduction may increase the feeling that stopping is possible   Many smokers prefer gradual vs. abrupt cessation   Spontaneous reduction + NRT use in smokers   Ambivalence, special group   Smokers must be treated like other addicts: have all of them do stg, either quit or reduce   Those not motivated to stop should not be excluded from treatment

6 New: « Cut down to stop »   NRT now licensed for « cut down to stop » (Pfizer term) in several countries   «…reducing the amount you smoke until you decide to give up completely. You should aim to do this in 6 months. » (Nicorette website)   New customers: smokers who use NRT for several months before they stop smoking   UK: NARS report (ASH: M. Raw, A. McNeill, R. West)   UK: NICE report in preparation   Where does the evidence come from ?

7 Long-term NRT-aided reduction in smokers not willing to quit   Review 19 studies (Hughes, Addiction 2005;100:1074)   NRT for 2-12 months (25 th -75 th percentiles)   ActiveControlRR   CPD reduced:   % reduced:25-56%13-26%   Achieved 50% reduc:8-27%2-22%

8 NARS report, NRT license for CDTS   Based on long-term NRT-aided reduction studies in smokers not motivated to stop…  ...but CDTS is licensed as a strategy to stop gradually   Recommendation CDTS for 6 months is arbitrary   CDTS not based on short-term pre-cessation NRT in smokers motivated to quit   … because 2-4 additional weeks of treatment not worth the effort of getting this approach licensed?

9 Short-term (1-2 weeks) pre-cessation NRT in smokers willing to quit: 3 studies NProduct Durat° pre-tx PlaceboFollow- up Quit rate pre-tx vs control RRP-value Herrera Chest Gum 1 week No6 weeks 61% vs 52% 1.2NS Schuurmans Addiction Patch 2 weeks Yes6 months 22% vs 9% in 16+ cig Rose Nicotine Tob Res Patch 2 weeks Yes6 months 20.8% vs 12.5%

10 3 studies NRT for 1-2 weeks pre-cessation

11 Shiffman 2006 study   Gradual cessation with NRT   N=3200   2 or 4 mg gums or placebo for 4-8 weeks pre quit   NRT for 12 weeks post quit, up to 12 months   Results at 6 months (4 mg): OR = 6 (over placebo)   Presented at WCTOH, Washington, July 2006

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13 Ongoing study in Geneva   Easier to quit if one smokes fewer cigarettes / day   4 mg: strong taste   Poor compliance   Hypothesized mechanisms of pre-cessation NRT: - reduce cigarette consumption - increase N gums during first crucial days a after cessation - break automatic association nicotine = cigarette

14 Geneva study   Aim: test if treatment with 4 mg nicotine gums is more effective if it starts 4 weeks before the quit date   2 groups compared: 1) gums 1 month before + 2 months after 2) gums 2 months after quit date   Randomized trial   No placebo

15 Geneva study   Gums sent by mail   No face-to-face counseling   Advice to use clinics, quitlines, web   15+ cig./day.   GE + VD

16 Follow-up   4 times   Quit date, end of treatment (2 mo), 1 yr, 5 yrs   Saliva cotinine after 12 months   CO at 12 months if quit and cotinine >10 ng/ml   215 participants (September 13, 2006)   Follow-up rate: - 98% at quit date - 94% at end of treatment

17 Conclusions   Long –term NRT reduction increases quit rates in smokers not trying to quit   Short-term (1-2 weeks) pre-cessation NRT increases quit rates in smokers trying to quit (RR = 1.2 – 2.4)   Paradoxically, NRT is licensed pre-cessation (CDTS) for smokers who do not want to stop, but not for those who do

18 Implications   Smokers should be reminded that quitting is best   All smokers should receive treatment + support   Smokers who prefer gradual quitting may use NRT   Possibility that it may weaken the ‘not a puff’ message ?   Population impact ?   To increase quit rates we need to: - increases taxes - ban smoking in public places - advocacy - evidence-based media campaigns

19 Get these slides on stop-tabac.ch


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