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Evidence for nicotine preloading ‘insufficient’, study finds

There is no clear evidence that nicotine ‘preloading’ helps smokers quit, as any beneficial effect may have been masked by a reduction in use of smoking cessation drugs, a study has found.

It suggested that using nicotine patches may make patients less likely to use stop-smoking medications like varenicline, undermining the benefits of preloading.

The study, which defined preloading as ‘using a nicotine replacement treatment (or other smoking cessation drugs) before a quit attempt while smoking normally’, was carried out by researchers at the University of Oxford and looked at just under 2,000 patients who were smokers.

Around half of the patients received nicotine patches for four weeks before their quit date as well as standard care consisting of pharmacotherapy and behavioural support, while the other half received standard care with additional behaviour support.

After nicotine preloading had ended, patients could choose whether to either continue with nicotine replacement or use non-nicotine drug therapy.

The researchers found that at six months following the quit date, 18% of patients in the nicotine patch group had achieved abstinence, compared to 14% in the control group, falling to 14% and 11% respectively at 12 months.

They found that patients who preloaded were less likely than those in the control group to use varenicline after their quit date, but that when this was adjusted for, preloading made patients more likely to quit.

The authors said in the paper: ‘Nicotine preloading … seems to be efficacious, safe, and well tolerated, but probably deters the use of varenicline, the most effective smoking cessation drug.

‘Evidence was insufficient to confidently show that nicotine preloading increases subsequent smoking abstinence.’

BMJ 2018; available online 13th June


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