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Study says anti-smoking pill beats the patch

SHARE Study says anti-smoking pill beats the patch

Trying to kick the smoking habit? Maybe you should add the pill to the patch.

In the first head-to-head comparison, the anti-smoking drug Zyban proved twice as good as the nicotine patch in helping people quit smoking -- and used together were even more effective.Used together, they helped more than 35 percent of smokers stay off cigarettes for a year.

The patch had disappointing results, working no better than a dummy pill or patch. But the researchers themselves disagreed over whether the findings were a fluke, since other studies have shown the patch works.

The study, led by Dr. Douglas Jorenby of the University of Wisconsin Medical School's Center for Tobacco Research and Intervention, was reported in today's New England Journal of Medicine. It was paid for by the maker of Zyban.

Using both methods at the same time was especially effective in helping people prevent weight gain during the first seven weeks. Those using both the patch and Zyban put on about 2.4 pounds, compared with 3.6 for either method alone and 4.6 on placebos, or dummy treatments.

"A lot of people say the fear of gaining weight stops them from even trying to quit smoking or can sabotage them early in the process," Jorenby said.

About 46 million Americans smoke, and it will eventually kill half of them, at a rate of about 400,000 a year. Three-quarters of smokers want to quit, but at most 5 percent manage to do so on their own.

Zyban is the brand name for the antidepressant bupropion. Since Zyban was approved in 1997 as the first non-nicotine product to help smokers quit, doctors have written 4 million prescriptions for it, according to Glaxo Wellcome Inc., the manufacturer.

"The very high success rate with bupropion is extremely encouraging," said Dr. Alan Leshner, director of the National Institute on Drug Abuse. Adding behavioral treatment to the mix should bring even more success, he said.

Glaxo Wellcome paid for the study. Jorenby has organized presentations for Glaxo Wellcome. Seven of the 11 other researchers also have worked for Glaxo Wellcome, Novartis -- which made the patches studied -- or a competitor in the quit-smoking business.

It took a habit of at least 15 cigarettes a day to qualify for the study. Smokers who were depressed were turned down. All 893 participants got patches to stick on and pills to take, but some of the patches and pills were dummies.

After four weeks, the patch had significantly better results than the placebo. Buproprion alone was more effective than the patch, and both treatments were better yet.

After a year, more than 35 percent of the people getting both treatments were still not smoking, compared with about 30 percent of those on bupropion alone. But only 16.4 percent of those on the patch were smoke-free, compared with 15.6 percent of those whose used placebo patches and pills.

Jorenby said the finding was a fluke. Other studies have shown about a 30 percent success rate for the patch, according to Dr. Neal Benowitz of the University of California at San Francisco.

"People who failed on nicotine once don't do very well if you re-treat with nicotine. My guess is that a fair number of people had tried a nicotine patch or nicotine gum before," Benowitz said.

The study did include people who had used patches before, but there wasn't any significant difference in their quit rates, said another of the researchers, Dr. Michael Fiore, director of the tobacco research center.

"I think the difference between bupropion and the patch is a real one," he said.