Although clinical trials of nicotine replacement therapy (NRT) have consistently demonstrated higher rates of smoking cessation, the effectiveness of NRT may be lower in real-world settings, especially in the absence of behavioral support.  Accordingly, there is a need for randomized clinical trials to evaluate the effectiveness of NRT alone.  Cunningham et al conducted a randomized trial on adult smokers across Canada testing the impact of mailing nicotine patches to smokers without behavioral support on quit rates.  A total of 500 adults smoking more than 10 cigarettes daily were randomized to the experimental arm (mailed a 5-week supply of nicotine patches) or control arm (no nicotine patches mailed).  The primary outcome was self-reported abstinence from smoking at 6 months.  Self-reported nicotine abstinence rates were higher in the experimental arm (OR 2.65, 95% CI 1.44-4.89, p=0.002).  Of those who claimed abstinence, biochemical validation via saliva analysis for cotinine was available in 50.9%.  Biochemically validated abstinence at 6 months was found in 14 patients (2.8%) of 500 in the experimental cohort compared to 5 (1.0%) of 499 in the control group (OR 2.85, 95% CI 1.02-7.96, p=0.046).

Conclusion:  This work suggests access to nicotine patches alone, without concurrent behavioral support, promotes tobacco cessation.  However, low rates of biochemically validated smoking cessation limits the significance of the study findings.

Summarized by Amneet Sandhu and Steven M. Bradley

Cunningham JA, Kushnir V, Selby P, Tyndale RF, Zawertailo L and Leatherdale ST.  Effect of Mailing Nicotine Patches on Tobacco Cessation Among Adult Smokers: A Randomized Clinical Trial.  JAMA Intern Med. 2016: 176(2): 184-190.