Yudkin P L, Jones L, Lancaster T, Fowler G H
Department of Public Health and Primary Care, University of Oxford.
Br J Gen Pract. 1996 Mar;46(404):145-8.
Nicotine replacement therapy is effective in helping people to give up smoking. The three forms now available--transdermal patches, chewing gum and nasal spray--deliver nicotine at different rates and to different levels. Therefore, it might be expected that smokers with different characteristics, and at different levels of nicotine dependence, will be helped more by one or other method.
The aim of the study was to examine whether the effectiveness of transdermal patches is related to nicotine dependence or to other smoker characteristics and to investigate factors predicting smoking cessation using patches.
Data from a randomized, double-blind, placebo-controlled trial of nicotine transdermal patches were analysed retrospectively. The trial, conducted in 1990-1992, involved 1686 patients recruited from 19 general practices in Oxfordshire. The main outcome measure was continuous smoking cessation from 8 to 52 weeks after the start of patch use, biochemically validated at 12, 24 and 52 weeks. The effectiveness of the patches was measured by the relative odds of sustained cessation using nicotine patches compared with placebo patches.
Nicotine transdermal patches were more effective in smokers with moderate nicotine dependence [odds ratio (OR) 1.94; 95% confidence interval (CI) 1.24-3.04] than in mildly or highly dependent smokers (OR 0.98; 95% CI 0.58-1.65) (difference in ORs P < 0.05) and more effective in those aged 24-49 years (OR 1.89; 95% CI 1.24-2.87) than in older smokers aged 50-65 years (OR 0.88; 95% CI 0.49-1.59) (difference in ORs P < 0.05). Abstinence from smoking in the first week of the trial was the strongest predictor of sustained cessation and was more common among smokers using nicotine patches than those using placebo patches (33% of 842 compared with 22% of 844; P < 0.001). Of first-week abstainers, 25 and 28% of 277 and 182 in the nicotine and placebo groups, respectively, achieved sustained cessation compared with 4% of 565 and 2% of 662 first-week smokers.
Nicotine transdermal patches were most effective for smokers with moderate nicotine dependence and for younger smokers. Early abstinence from smoking was the strongest predictor of sustained cessation. A week's trial of the patch proceeding to longer term use if abstinence is achieved may be an effective policy.
尼古丁替代疗法在帮助人们戒烟方面是有效的。目前可用的三种形式——透皮贴片、口香糖和鼻喷雾剂——以不同的速率和达到不同的水平来递送尼古丁。因此，可以预期，具有不同特征以及处于不同尼古丁依赖水平的吸烟者，会从一种或另一种方法中得到更多帮助。
该研究的目的是检验透皮贴片的有效性是否与尼古丁依赖或其他吸烟者特征相关，并调查预测使用贴片戒烟的因素。
对一项尼古丁透皮贴片的随机、双盲、安慰剂对照试验的数据进行回顾性分析。该试验于1990年至1992年进行，涉及从牛津郡19家普通诊所招募的1686名患者。主要结局指标是从开始使用贴片后的8周到52周持续戒烟，并在12周、24周和52周进行生化验证。通过使用尼古丁贴片与安慰剂贴片相比持续戒烟的相对比值比来衡量贴片的有效性。
尼古丁透皮贴片对中度尼古丁依赖的吸烟者更有效[比值比（OR）1.94；95%置信区间（CI）1.24 - 3.04]，而对轻度或高度依赖的吸烟者效果较差（OR 0.98；95% CI 0.58 - 1.65）（OR差异P < 0.05）；对年龄在24 - 49岁的吸烟者更有效（OR 1.89；95% CI 1.24 - 2.87），而对年龄在50 - 65岁的老年吸烟者效果较差（OR 0.88；95% CI 0.49 - 1.59）（OR差异P < 0.05）。试验第一周戒烟是持续戒烟的最强预测因素，且在使用尼古丁贴片的吸烟者中比使用安慰剂贴片的吸烟者更常见（842人中的33%与844人中的22%；P < 0.001）。在第一周戒烟者中，尼古丁组和安慰剂组分别有277人中的25%和182人中的28%实现了持续戒烟，而第一周吸烟的565人和662人中分别只有4%和2%实现了持续戒烟。
尼古丁透皮贴片对中度尼古丁依赖的吸烟者和年轻吸烟者最有效。早期戒烟是持续戒烟的最强预测因素。如果实现了戒烟，进行一周的贴片试验然后继续长期使用可能是一种有效的策略。
