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A Randomized Trial

Jean-François Etter, PhD, MPH; Philippe Huguelet, MD; Thomas V. Perneger, MD, PhD; Jacques Cornuz, MD

Arch Intern Med. 2009;169(11):1028-1034.

Background  New ways of improving the efficacy of nicotine therapy need to be explored. We tested whether starting nicotine polacrilex gum treatment 4 weeks before the quit date improved smoking abstinence rates compared with starting treatment on the quit date.

Methods  An open randomized trial of 314 daily smokers (mean, 23.7 cigarettes/d) enrolled through the Internet and by physicians in Switzerland from November 2005 to January 2007. In the precessation treatment group, participants received nicotine polacrilex gum (4 mg, unflavored) by mail for 4 weeks before and 8 weeks after their target quit date, and they were instructed to decrease their cigarette consumption by half before quitting. In the usual care group, participants received the same nicotine gum for 8 weeks after their quit date and were instructed to quit abruptly. Instructions were limited to a booklet sent by mail and access to a smoking cessation Web site. Results are expressed as self-reported abstinence rates at the end of treatment and as biochemically verified smoking abstinence (cotinine plus carbon monoxide) after 12 months.

Results  Eight weeks after the target quit date, self-reported 4-week abstinence rates were 41.6% in the precessation treatment group and 44.4% in the usual care group (P = .61). One year after the target quit date, biochemically verified 4-week smoking abstinence rates were 20.8% in the precessation treatment group and 19.4% in the usual care group (P = .76).

Conclusion  Starting nicotine gum treatment 4 weeks before the target quit date was no more effective than starting treatment on the quit date.

Trial Registration  isrctn.org Identifier: ISRCTN60585119

Author Affiliations: Institute of Social and Preventive Medicine, Faculty of Medicine, University of Geneva (Dr Etter), and Department of Psychiatry (Dr Huguelet) and Division of Clinical Epidemiology (Dr Perneger), Geneva University Hospitals, Geneva, and Department of Ambulatory Care and Community Medicine, Faculty of Biology and Medicine, University of Lausanne, Lausanne (Dr Cornuz), Switzerland.

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