Triple therapy boosts quit rates in sick smokers

NEW YORK (Reuters Health) - In smokers with chronic illnesses, a combination of a nicotine patch, a nicotine inhaler and an antidepressant increases quit rates compared with standard therapy with a nicotine patch only, a study published today shows.

"Medically ill smokers are often highly addicted and at great risk for complications from continued smoking," study chief Dr. Michael B. Steinberg, of the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, said in a prepared statement. "Our trial demonstrates that intensive treatment with a triple combination of medications could work well for them."

The study involved 127 smokers, who expressly wanted to quit, with illnesses such as heart disease, lung disease, cancer, and diabetes. The smokers were randomly assigned to receive a nicotine patch for 10 weeks or a combination of a nicotine patch, a nicotine inhaler, and the antidepressant bupropion for as long as needed.

At about six months, the patients in the combination therapy group had a success rate of approximately 35 percent. By contrast, the nicotine patch group achieved only a 19 percent success rate.

"The simultaneous use of nicotine medications with bupropion addresses tobacco withdrawal through different mechanisms of action," Steinberg's team points out in the Annals of Internal Medicine, while the combination of a patch with an inhaler "to be used in response to cravings allows more individualized delivery of medication as needed."

"Even though persons with medical illnesses smoke at high rates, they are often not prescribed intensive smoking cessation pharmacotherapy because of concern about adverse events," the investigators point out. The current study, they say, is one of only a handful that has looked at interventions for these high-risk patients.