Does adding patches to varenicline + counseling help?

While offering patients who smoke cigarettes counseling as well as a prescription to varenicline helps them to quit, it turns out that also adding nicotine patches to those other two treatments doesn’t add much.

These findings were published in the journal Drug and Alcohol Dependence, with former UW-CTRI researcher and current collaborator Dr. Nayoung Kim as lead author.

Kim and her co-authors conducted secondary analyses of ecological momentary assessment data captured in real time by mobile devices in a clinical trial of tobacco cessation treatment that tested whether adding nicotine patches to varenicline and counseling helps people quit smoking.

Using novel time-varying effect modeling, the authors examined when and how the addition of nicotine patches influence smoking abstinence (via withdrawal symptoms) to better understand why the treatment may not always be effective.

The results demonstrated that craving, other withdrawal symptoms and lack of confidence predicted next-day smoking in the initial days of trying to quit smoking. Active nicotine patches did not suppress these symptoms better than placebo patches.

“Nightly ratings of nicotine withdrawal symptoms predicted next-day smoking,” Kim said. “Meanwhile, positive mood and their confidence they could quit did predict smoking abstinence the following day.”

Co-author and UW-CTRI Research Director Dr. Danielle McCarthy pointed out that they found that adding nicotine patches to varenicline and counseling did boost the odds that participants who quit smoking would feel better and were able to stay quit during the first weeks of a quit attempt, but it did not improve craving or other withdrawal symptoms.

Adding patches to varenicline and counseling did not seem to improve the symptoms that increase risk for continued smoking.

Kim N, Baker TB, Coffman DL, Piper ME, Stein JH, McCarthy DE. Time-varying Mediated Effects of the Nicotine Patch on Smoking Before and After a Quit Attempt When it is Added to Varenicline and Counseling. Drug and Alcohol Dependence.