Smoking-cessation drugs and many nicotine-replacement therapies are more than twice as effective at helping smokers quit than going it alone.

A new analysis of 69 studies comparing seven different smoking-cessation treatments shows six of the seven treatments were more effective than placebo in helping smokers quit the habit for at least six months to a year.

But researchers say smoking-cessation therapies are underused because of problems translating those results to the public and providing widespread access to the treatments.

“We are confident that the recommended treatments will substantially increase rates of smoking abstinence when given to smokers who wish to quit,” researcher John Cunningham of Toronto’s Centre for Addiction and Mental Health, says in a news release.

For example, Cunningham says these results suggest that offering free nicotine-replacement therapy to adults who want to quit smoking could provide major public health benefits.

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Helping Smokers Quit

In the study, published in the Canadian Medical Association Journal, researchers compared 69 clinical trials on smoking- cessation therapies involving nearly 33,000 people.

The results showed six therapies were more effective than placebo at helping smokers quit, including:

* Chantix (2.4 times more effective than placebo)
* Nicotine nasal spray (2.37)
* Zyban (also known as Wellbutrin) (2.07)
* Nicotine patch (2.07)
* Nicotine tablet (2.06)
* Nicotine gum (1.71)

Although the findings also favored the effectiveness of the nicotine inhaler over placebo, the results were not conclusive.

In a related article in the same journal, Canadian researchers randomly surveyed 825 smokers and asked them if they would be interested in receiving free nicotine-replacement therapy and how they would use it. Nearly 60% of smokers said they would be interested in receiving free nicotine-replacement therapy, and 94% of the interested smokers said they would use it to quit smoking for good.

In fact, researchers found smokers who were interested in quitting smoking for good were more interested in using nicotine-replacement therapy than those who planned to cut back or maintain their smoking habits.

Experts say these results suggest that new strategies to inform smokers who want to quit about their options may be needed to improve use of smoking-cessation therapies.

“Because of a powerful multinational tobacco industry, the need to prevent death and disability from tobacco-related illnesses will not disappear,” writes J. Taylor Hayes, MD, of the Mayo Clinic in a commentary in the same journal. “However, we have effective treatments to assist smokers at their attempts to live free of tobacco. The success of our efforts hinges on our ability to place these products in the hands of people who need them.”

Cigarette smokers who try to quit gradually rather than giving up smoking all at once can safely use nicotine-replacement gum, a new study shows.

Heavy smokers in the study who chewed the highest doses of nicotine-replacement gum as they tried to cut down on their smoking reported no more side effects than lighter smokers who chewed less nicotine gum.

The research was funded by GlaxoSmithKline, which markets Nicorette — the nicotine- replacement gum used in the study. The study appears in the February issue of the American Journal of Preventive Medicine.

For the first two months of the study, the smokers were told to gradually reduce their smoking while increasing their nicotine gum use, with the goal of giving up cigarettes altogether.

Compared to smokers randomly assigned to a group using a placebo instead of nicotine gum, use of nicotine gum appeared to triple the odds of being a nonsmoker at six months.

Just 2% of placebo-gum users achieving this goal, compared to 6% of nicotine-gum users.

“Nicotine-replacement therapies like gums and patches are approved for abrupt quitting, but many people prefer to try and quit gradually by cutting down cigarettes rather than giving them up all at once,” study researcher Saul Shiffman, PhD, tells WebMD. “Our finding is very reassuring because it shows this to be a safe way to use these products.”

Smokers Who Quit Gradually

Studies suggest that only about 3% of attempts to stop smoking without the aid of nicotine replacement, other medications, behavioral therapy, or some other type of treatment are successful.

Shiffman, who is a long-time smoking-cessation researcher as well as a consultant for GlaxoSmithKline, says many smokers who want to quit express a preference for quitting gradually.

But it has not been known if they could safely do so using nicotine-replacement products at the same time.

In an effort to study this, the University of Pittsburgh professor of psychology and colleagues recruited almost 3,300 smokers from across the country. All had expressed an interest in quitting smoking gradually instead of stopping “cold turkey.”

The smokers were allowed to choose either 2-milligram or 4-milligram doses of nicotine gum, but some of the participants in both groups unknowingly got a placebo rather than active-nicotine gum.

The 4-milligram dosage is generally recommended for heavy smokers — those who typically smoke 25 or more cigarettes a day.

Participants were instructed to cut down on cigarettes while increasing their use of the gum over a two-month period, but they were not given explicit instructions on how to do this, Shiffman says. Participants reviewed FDA-approved labeling for the gum products.

Those who reported giving up cigarettes at the end of two months were followed for an additional four months, during which time they were allowed, but not required, to continue using the nicotine-replacement gum or a placebo.

During the first four weeks of the study, the researchers evaluated the impact of simultaneous use of cigarettes and nicotine-replacement gum.

They found no difference in adverse outcomes among the heaviest nicotine users (who averaged 22 cigarettes a day and nine pieces of 4-milligram gum) compared to people who used less nicotine.

At the end of six months, smokers on active nicotine-replacement therapy were more likely to have stopped smoking than those who chewed the placebo gum.

Shiffman acknowledges that the success rate for all the study participants was low. But the 6% quit rate for the smokers who chewed the 4-milligram nicotine-replacement gum was roughly double that typically reported in studies evaluating smokers who try to quit without help.

Nicotine Gum ‘Better Than Smoking

The study did not examine nicotine gum use for longer than six months, but it is clear that many people stay on the gum or other forms of nicotine-replacement therapy for much longer.

New York University professor of medicine and smoking-cessation researcher Scott Sherman, MD, tells WebMD that the evidence suggests that long-term use of nicotine-replacement treatments is safe and “a whole lot better for you than smoking.”

While nicotine is the agent that gets people hooked on cigarettes, other chemical toxins in cigarette smoke are the cause of lung cancer and other health effects.

But while long-term use of nicotine-replacement products appears safe, Sherman says there is less evidence that it is effective.

“It is not really clear if using nicotine gum or patches or even other forms of medication for a year instead of three months improves your chances of quitting smoking,” he says. “We can’t really tell people that they will be more likely to be a nonsmoker 10 years down the road if they chew nicotine gum for an extra year.”

Sherman says that people who are trying to quit smoking typically use too little medication rather than too much. “A common mistake people make with gums and lozenges is that they wait until they feel symptoms, and that’s too late.”

Sherman and Shiffman offered other tips for stopping smoking:

* Use medication. People who use nicotine-replacement therapies or other types of drugs approved for smoking cessation are twice as likely to quit successfully, Sherman says.
* Get some support. Most states have smoking-cessation hotlines that can provide counseling and information for people trying to quit.
* Recognize your smoking triggers and have a plan for dealing with them.

If your first attempt to quit smoking doesn’t work, you’re not alone. The average person who successfully gives up cigarettes had tried to quit unsuccessfully at least half a dozen times, Sherman says. “Rather than beat yourself up and feel defeated, these unsuccessful attempts should be viewed as learning opportunities.”