Clinical strategies to enhance the efficacy of nicotine replacement therapy for smoking cessation: a review of the literature

Emerging drugs for the treatment of tobacco dependence: 2014 update

INTRODUCTION

Tobacco dependence remains a global epidemic and the largest preventable cause of morbidity and mortality around the world. Smoking cessation has benefits at all ages but remains challenging for several reasons, among which are the complexities of nicotine addiction and limitations of available pharmacotherapies.

AREAS COVERED

This review summarizes current and emerging pharmacotherapies for the treatment of tobacco dependence, including first- and second-line recommended agents. Medications with alternative primary indications that have been investigated as potential treatments for tobacco dependence are also discussed. Articles reviewed were obtained through searches of PubMed, Ovid MEDLINE, ClinicalTrials.gov and the Pharmaprojects database.

EXPERT OPINION

Current evidence suggests that the two most effective pharmacotherapies to treat tobacco dependence are varenicline and combination nicotine replacement therapy. Alternative agents investigated demonstrate mixed rates of success in achieving long-term abstinence from smoking. No single pharmacotherapy will serve as a universally successful treatment given the complex underpinnings of tobacco dependence and individuality of smokers. The ultimate goal of tobacco research with respect to pharmacotherapeutic development continues to be providing clinicians with an armamentarium of drugs to choose from allowing for tailoring of treatment for smokers.

Effectiveness of electronic aids for smoking cessation

Tobacco use continues to be the leading cause of preventable death in the world, and though current evidence-based approaches have substantially reduced rates of smoking, these rates remain disturbingly high. Two recent technological advancements, the electronic cigarette (e-cigarette) and mobile health (mHealth) interventions, may offer smokers an alternative way to quit smoking. E-cigarettes continue to be fiercely debated. Preliminary evidence suggests that e-cigarettes are likely much safer than regular cigarettes and are helpful to some smokers as a means of reducing or quitting smoking. Questions, however, still remain as to how they will affect overall public health-if they will be used as a "gateway" product or reduce motivation to quit smoking, to name but a few. Similarly, mHealth interventions appear to be effective and accepted by users. However, mobile 'apps' have yet to be tested in randomized trials and there are concerns about violations of users privacy and state jurisdictions.

Is a cancer diagnosis a teachable moment for the patient's relative who smokes?

PURPOSE

This study examined a cancer diagnosis, versus orthopedic surgery, as a teachable moment for recruiting smokers and treating nicotine dependence among patients' relatives.

METHODS

Cancer patients and, for comparison, orthopedic patients at the University of Pennsylvania Health System were approached for referrals of relatives for a smoking cessation program, which involved behavioral counseling and nicotine patches. Primary outcomes were rate of program enrollment and rate of smoking abstinence. Potential mediators of smoking cessation were explored (e.g., treatment adherence, depression, anxiety). Two hundred and thirty-four relatives (113 cancer, 121 orthopedic) were considered eligible for the cessation program and comprised the study sample.

RESULTS

Relatives of oncology patients were significantly more likely to enroll in the smoking cessation program, vs. orthopedic relatives (75 % vs. 60%; OR = 1.96, 95% CI 1.07-3.61, p = .03), but they were not significantly more likely to remain in the program (61% vs. 52%) or quit smoking (19% vs. 26%; p's > .05). Compared to orthopedic relatives, oncology relatives showed significantly lower nicotine patch adherence and significantly greater levels of negative affect and depression and anxiety symptoms during treatment (p's < .05). Further, orthopedic relatives, compared to oncology relatives, showed a greater reduction in the perceived benefits of smoking (p = .06), which was significantly associated with abstinence (p = .02).

CONCLUSIONS

While a family member's cancer diagnosis may serve as a teachable moment for a smoker to enroll in a smoking cessation treatment program, high levels of psychological distress and perceptions of the benefits of smoking and low levels of treatment adherence may undermine successful abstinence among this population.