Nicotine replacement therapy Robert West Professors of Health Psychology University College London

This talk Types of NRT New products New methods of using NRT Effectiveness Next steps

Main types of NRT Transdermal patch Chewing gum 16h: up to 25mg 24h: up to 21mg Chewing gum up to 4mg Lozenge and sublingual tablet Inhaler Nasal spray

New products Marketed 25mg 16h Nicorette patch 1.5mg and 4mg Niquitin minis Zonnic mouthspray, pouch and gum Others Rapid release gum ‘Nicotine cannon’ Nicotine straw etc.

New methods of using NRT Pre-loading use product for fixed period prior to a definite quit date; not necessary to cut down cigarette consumption Patch plus use nicotine patch plus more rapid form of delivery concurrently Reduce then quit/cut down then stop use product for indefinite period with a view to setting a quit date in the next few months; aim to cut down cigarette consumption

Effectiveness review Cochrane 2008 95% confidence intervals: blue blocks are direct estimates; red blocks are synthetic estimates; Moore et al 2009

Predictors of quitting in an English population sample 5701 smokers who reported having tried to stop in the past year 736 reported still not smoking Success was significantly lower with higher: time spent with urges, strength of urges, previous attempts in past year Success was significantly higher with: age, abrupt cessation, behavioural support, NRT Rx, Champix * * * * * * * * * All predictors adjusted for, plus time since attempt started, * p<0.05

Next steps Beginning to see improvement with new methods of using NRT widening indications improving outcomes Innovation in new products is being stifled by regulation, particularly FDA Concerns emerging about unsupervised use in a mature market: suggests key role for interventions to ensure effective use