Over the last several years, Lerman and colleagues have found that individuals who metabolize nicotine relatively slowly benefit from nicotine patch therapy more than people who metabolize it quickly. The fast metabolizers do better with drug therapy, such as bupropion (Zyban), as compared with the patch.
Now, in a randomized blinded clinical trial, Lerman’s team found that slow metabolizers benefit from extended treatment with the patch, according to findings presented at the American Association of Cancer Research meeting this week. At the end of six months of therapy, slow metabolizers who had six months of therapy were more than twice as likely to be abstinent as were slow metabolizers who had had only eight weeks of patch therapy followed by placebo patch for the remainder of the time. However, six months after therapy stopped for everyone there was no longer a difference between the treatment groups.
“Extended therapy helps people stay quit and recover from lapses, but it only works as long as people are on it,” says Lerman, who presented these data at a session on Tuesday, April 20th, devoted to lung cancer risk and addiction. “Those data lead to the compelling question of whether some smokers should be on nicotine patch therapy for the long term.” Lerman says the new data suggest that the guidelines for nicotine replacement therapy need to be reconsidered so that patients receive therapy longer than the current standard of eight weeks.
The team saw no difference in response to short or extended duration in fast metabolizers, further supporting their past results indicating that these individuals, which make up three-quarters of the population, need a different type of treatment. With that in mind, Lerman’s team is planning a nation-wide randomized trial to test the effectiveness of tailoring treatment – patch versus drug therapy – based on an individual’s nicotine metabolism rate.
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