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

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

3. 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

4. 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.

5. 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

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

7. 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

8. 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