Nicotine replacement therapy … - Carlos A ... - Entretiens du Carla

Conclusion 1
Nicotine Replacement Therapy
State of the art
Nicotine replacement therapy (NRT) is the
oldest and best evaluated therapy in the
fight against tobacco use. According to a
meta-analysis of 132 trials (> 40,000 smokers)
including a 12-month follow-up period, the
odds ratio for smoking abstinence compared
to a placebo is 1.58 (IC 95%:1.66 to 1.88).
The benefit/risk ratio is optimal in
comparison to other pharmacological
treatments.
1.1. Choosing the optimal NRT dose is a
key factor to succeed
NRT follow-up is crucial to adjust doses
(according to clinical symptoms and the level
of CO in expired air), potentially combine
oral administration forms and transdermal
absorption forms.
NRT has proven to be efficacious without
psychological support. Nevertheless,
combining the use of NRT with psychological
support increases the likelihood to quit.
1.2. Drug treatments are indicated for
dependent patients
Generally, the pharmacological
dependence is assessed with the Fagerström
Test for Nicotine Dependence (FTND).
Although the FTND score is not a criterion to
prescribe NRT, average and high dependence
scores suggest the use of NRT in order to
reduce withdrawal symptoms.
1.3. Usefulness of NRT lies on:
- the largely demonstrated efficacy with
long-term follow-up,
- the very low risk of serious adverse
effects,
- the harmless nature of the adverse
effects (often related to the route of
administration).
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1.4. In case of comorbidities
Because of the very favorable adverse
effect profile, NRT can be prescribed in the
case of comorbidities (coronary artery
disease, peripheral atherosclerosis, chronic
obstructive pulmonary disease [COPD],
severe kidney failure, neuropsychiatric
disorders, etc).
Conclusions