Does cigarette reduction while using nicotine replacement therapy prior to a quit attempt predict abstinence following quit date?

Lindson, Nicola; Shinkins, Bethany; West, Robert; Michie, Susan; Aveyard, Paul

doi:10.1111/add.13330

Cited by 9 publications

(5 citation statements)

References 17 publications

(36 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our previous trial using NRT to help gradual cessation in smokers found that smoking reduction predicted subsequent abstinence, 10 which was consistent with a recent UK study which showed that smokers who used NRT consciously attempted to reduce cigarette consumption. 23 Longer-term studies, such as those involving 1-year follow-up, are needed to evaluate the effectiveness of CDTQ in achieving smoking abstinence.…”

Section: Discussionmentioning

confidence: 99%

Brief Advice on Smoking Reduction Versus Abrupt Quitting for Smoking Cessation in Chinese Smokers: A Cluster Randomized Controlled Trial

Wang

Cheung

et al. 2017

Nicotine &Amp; Tobacco Research

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Brief Advice on Smoking Reduction Versus Abrupt Quitting for Smoking Cessation in Chinese Smokers: A Cluster Randomized Controlled Trial

Wang

Cheung

et al. 2017

Nicotine &Amp; Tobacco Research

View full text Add to dashboard Cite

show abstract

“…However, subsequent planned replication found evidence that the effect was much less strongly predictive of the ability to quit smoking during nicotine preloading. 25 We, therefore, planned to examine the effectiveness of preloading in a trial powered to detect modest effects on long-term abstinence and investigate potential mediators that could allow therapists to judge whether to continue or abandon preloading. The objectives were to: l examine the relative efficacy of a nicotine patch worn for 4 weeks prior to quitting plus standard NHS care post quit compared with standard NHS care only in smokers undergoing NHS treatment for tobacco dependence (addressed in Chapter 3) l examine the adverse effects and safety of nicotine preloading (addressed in Chapter 3) l examine the incremental cost-effectiveness of nicotine preloading (addressed in Chapters 6 and 7) l examine possible mediating pathways between nicotine preloading and outcomes (addressed in Chapter 4) l examine moderators of the effects of preloading, including the use of varenicline and baseline levels of dependence (addressed in this chapter and in Chapter 4) l investigate opinions of the preloading intervention (addressed in Chapter 5) l assess adherence to preloading treatment and subsequent standard smoking cessation pharmacotherapy (addressed in Chapter 3).…”

Section: Cost-effectivenessmentioning

confidence: 99%

“…Abstinence rate (%) at 6 months post quit date, mean (95% CI) 25 This study has several strengths. Chief among these are that we planned a comprehensive evaluation of the mechanism of action, assessing all steps in the pathway, and we included analyses of competing hypotheses that were advanced to explain the preloading effect.…”

mentioning

confidence: 99%

Nicotine preloading for smoking cessation: the Preloading RCT

Aveyard

Lindson

Tearne

et al. 2018

Health Technol Assess

Self Cite

View full text Add to dashboard Cite

BackgroundNicotine preloading means using nicotine replacement therapy prior to a quit date while smoking normally. The aim is to reduce the drive to smoke, thereby reducing cravings for smoking after quit day, which are the main cause of early relapse. A prior systematic review showed inconclusive and heterogeneous evidence that preloading was effective and little evidence of the mechanism of action, with no cost-effectiveness data.ObjectivesTo assess (1) the effectiveness, safety and tolerability of nicotine preloading in a routine NHS setting relative to usual care, (2) the mechanisms of the action of preloading and (3) the cost-effectiveness of preloading.DesignOpen-label randomised controlled trial with examination of mediation and a cost-effectiveness analysis.SettingNHS smoking cessation clinics.ParticipantsPeople seeking help to stop smoking.InterventionsNicotine preloading comprised wearing a 21 mg/24 hour nicotine patch for 4 weeks prior to quit date. In addition, minimal behavioural support was provided to explain the intervention rationale and to support adherence. In the comparator group, participants received equivalent behavioural support. Randomisation was stratified by centre and concealed from investigators.Main outcome measuresThe primary outcome was 6-month prolonged abstinence assessed using the Russell Standard. The secondary outcomes were 4-week and 12-month abstinence. Adverse events (AEs) were assessed from baseline to 1 week after quit day. In a planned analysis, we adjusted for the use of varenicline (Champix®; Pfizer Inc., New York, NY, USA) as post-cessation medication. Cost-effectiveness analysis took a health-service perspective. The within-trial analysis assessed health-service costs during the 13 months of trial enrolment relative to the previous 6 months comparing trial arms. The base case was based on multiple imputation for missing cost data. We modelled long-term health outcomes of smoking-related diseases using the European-study on Quantifying Utility of Investment in Protection from Tobacco (EQUIPT) model.ResultsIn total, 1792 people were eligible and were enrolled in the study, with 893 randomised to the control group and 899 randomised to the intervention group. In the intervention group, 49 (5.5%) people discontinued preloading prematurely and most others used it daily. The primary outcome, biochemically validated 6-month abstinence, was achieved by 157 (17.5%) people in the intervention group and 129 (14.4%) people in the control group, a difference of 3.02 percentage points [95% confidence interval (CI) –0.37 to 6.41 percentage points; odds ratio (OR) 1.25, 95% CI 0.97 to 1.62;p = 0.081]. Adjusted for use of post-quit day varenicline, the OR was 1.34 (95% CI 1.03 to 1.73;p = 0.028). Secondary abstinence outcomes were similar. The OR for the occurrence of serious AEs was 1.12 (95% CI 0.42 to 3.03). Moderate-severity nausea occurred in an additional 4% of the preloading group compared with the control group. There was evidence that reduced urges to smoke and reduced smoke inhalation mediated the effect of preloading on abstinence. The incremental cost-effectiveness ratio at the 6-month follow-up for preloading relative to control was £710 (95% CI –£13,674 to £23,205), but preloading was dominant at 12 months and in the long term, with an 80% probability that it is cost saving.LimitationsThe open-label design could partially account for the mediation results. Outcome assessment could not be blinded but was biochemically verified.ConclusionsUse of nicotine-patch preloading for 4 weeks prior to attempting to stop smoking can increase the proportion of people who stop successfully, but its benefit is undermined because it reduces the use of varenicline after preloading. If this latter effect could be overcome, then nicotine preloading appears to improve health and reduce health-service costs in the long term. Future work should determine how to ensure that people using nicotine preloading opt to use varenicline as cessation medication.Trial registrationCurrent Controlled Trials ISRCTN33031001.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 22, No. 41. See the NIHR Journals Library website for further project information.

show abstract

“…Prior research has also found inconsistent effects from reduction-based interventions among smokers who are motivated to quit (Lindson, Klemperer, et al, 2019; Lindson et al, 2020). However, there is some evidence to suggest that, a greater magnitude of reduction in smoking is associated with QAs (Klemperer, Hughes, & Naud, 2019) and cessation among smokers not ready to quit who received a reduction intervention (Lindson-Hawley, Shinkins, et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of interventions to induce attempts to quit tobacco among adults not ready to quit.

Klemperer¹,

Streck²,

Lindson³

et al. 2023

Experimental and Clinical Psychopharmacology

View full text Add to dashboard Cite

The prevalence of past-year smoking cessation remains below 10% in the U.S. Most who smoke are not ready to quit in the near future. Cessation requires both (a) initiating a quit attempt (QA) and (b) maintaining abstinence. Most research has focused on abstinence among people already motivated to quit. We systematically reviewed interventions to promote QAs among people not motivated to quit tobacco. We searched PubMed, CENTRAL, PsycINFO, Embase, and our personal libraries for randomized trials of tobacco interventions that reported QAs as an outcome among adults not ready to quit. We screened studies and extracted data in duplicate. We pooled findings of the 25 included studies using Mantel–Haenszel random effects meta-analyses when ≥2 studies tested the same intervention. Most (24) trials addressed cigarettes and one addressed smokeless tobacco. Substantial heterogeneity among trials resulted in a series of small meta-analyses. Findings indicate varenicline may increase QAs more than no varenicline, n = 320; RR = 1.4, 95% CI [1.1, 1.7]; I2 = 0%, and nicotine replacement therapy (NRT) may increase QAs more than no NRT, n = 2,568; RR = 1.1, 95% CI [1.02, 1.3]; I2 = 0%. Pooled effects for motivational counseling, reduction counseling, and very low nicotine content cigarettes showed no clear evidence of benefit or harm. The evidence was judged to be of medium to very low certainty due to imprecision, inconsistency, and risk of bias, suggesting that further research is likely to change interpretation of our results. Findings demonstrate the need for more high-quality research on interventions to induce QAs among adults not ready to quit tobacco.

show abstract

Does cigarette reduction while using nicotine replacement therapy prior to a quit attempt predict abstinence following quit date?

Cited by 9 publications

References 17 publications

Brief Advice on Smoking Reduction Versus Abrupt Quitting for Smoking Cessation in Chinese Smokers: A Cluster Randomized Controlled Trial

Brief Advice on Smoking Reduction Versus Abrupt Quitting for Smoking Cessation in Chinese Smokers: A Cluster Randomized Controlled Trial

Nicotine preloading for smoking cessation: the Preloading RCT

A systematic review and meta-analysis of interventions to induce attempts to quit tobacco among adults not ready to quit.

Contact Info

Product

Resources

About