Researchers have found nicotine patches and lozenges to be the most efficacious, out of five different smoking cessation modalities, for quitting smoking.

The findings suggest 'combination pharmaco-therapy comprising the nicotine patch and an ad libitum nicotine replacement therapy should be routinely considered for use as a smoking cessation treatment,' the researchers said.

Researchers say, there is little comparative research can be found on the efficacy of different smoking cessation pharmaco-therapies, which evidence is essential for making informed decisions about which products to use and prescribe.

To find out, a randomized, double-blind, placebo-controlled trial was conducted by them, with 1,504-adults who had smoked 10-cigarettes a day for the six months previous, participating in the study.

Any patient who had used any form of tobacco other than cigarettes, or were taking bupropion (Zyban) currently, including having been diagnosed with psychosis or schizophrenia, were disqualified.

They were randomized to 1 of 5 treatment scenarios i. e. nicotine lozenge, nicotine patch, sustained-release bupropion, patch plus lozenge, or bupropion plus lozenge, or a placebo for 8 to 12- weeks.

Smoking rates were then assessed at 1-week, 8-weeks and 6-month intervals after the date they had quit smoking.

All quitting modalities were found to be better than the placebo for initial cessation.

Significant odds ratios after 6-months were as follows:

" Bupropion: OR 1.63.

" Lozenges: OR 1.76.

" Patch: OR 1.83.

" Bupropion plus lozenge: OR 1.74.

" Patch plus lozenge: OR 2.34.

An adjusted P-value of 0.0045 found only the patch-plus-lozenge group to have significantly higher abstinence rates after 6-months compared to P<0.001 of the placebo.

Except for the lozenge (P=0.003), analyses found all treatments increased the latency to relapse following the first lapse.

As well, patients in the patch-plus-lozenge group had significantly higher initial cessation rates and end-of-treatment abstinence rates, in comparison to those in mono-therapy groups.

The study's findings suggest, long-term pharmacotherapy i. e. more than 14-weeks is important, as the effects of bupropion plus lozenge diminish significantly, once study participants stopped using them towards the end of the treatment.

Adverse events were found to be more consistent with previous research e. g. skin irritation due to use of patch, those on bupropion suffered from sleep disturbances and abnormal dreams, and nausea for those on lozenges.

Combination therapies had more reports of adverse events than mono or placebo therapy, including one serious adverse event i. e. hospitalization for seizures.