Abstinence from Cigarette Smoking Nicotine chewing gum is most useful when combined with psychological treatment

Nicorette is an antismoking chewing gum. Each piece contains either 2mg or 4mg of nicotine, most of which is absorbed through the buccal mucosa within 30 min, depending on the rate of chewing. The cardiovascular effects are similar to those of a cigarette, but it appears that Nicorette alleviates withdrawal symptoms rather than providing pleasure. Five years ago it was suggested that Nicorette would be most useful in a clinical setting. Various trials have since been conducted and the results reviewed.

Nicorette was described as a useful aid after a 38% success rate was reported compared with a previous rate of 14% with psychological treatment in a 1-year study. Another 1-year placebo-controlled clinical study reported respective abstinence rates of 31 % and 14"10 for Nicorette and placebo. Group therapy was given to both groups and a 7% dependency rate was reported for the Nicorette group. Another similarly designed study reported only 13% abstinence with Nicorette compared with 9% for the placebo group. One group found that the superiority of Nicorette declined between 6 and 12 months to a non-significant difference compared with placebo. Within general practice Nicorette has had limited success. In one uncontrolled study a 9% Nicorette success rate was superior to either non-intervention or verbal and written advice (4% success in both cases). When 200 smokers were randomly assigned Nicorette or placebo in a double-blind trial abstinence rates of 10% and 8%, respectively, were reported after 6 months. Patients with smoking-related diseases showed no difference in response to Nicorette or placebo and only 10% had given up after 1 year in a study of 1550 patients. The most recent data available reports success rates of 29% and 16% for Nicorette vs placebo when both treatments were combined with group therapy. Another uncontrolled study where a physician's advice plus follow-up contact were supplemented with and without Nicorette reported success rates of 25% and 9%, respectively.

These results do not give a clearly defined role for Nicorette in antismoking therapy. Results in patients with smoking-related diseases have been disappointing, and further placebo-controlled studies within general practice are required. However, ' ... in the setting of a specialised smoking withdrawal clinic, Nicorette is superior to placebo and is of real benefit'. Lancet 1: 320·321 (9 Feb 1985)

0156-2703/85/0302-0003/0$01.00/0 © ADIS Press INPHARMA@ 2 Mar 1985 3