Stephen J.LurieMD, PhD, Senior Editor
In Reply: Dr Franzon and colleagues note that meta-analyses of randomized trials estimate the efficacy of NRT as doubling the rate of long-term successful cessation.1,2 Our data and that of others,3 however, suggest that its long-term effectiveness in the general population is less promising. There are many possible reasons for this discrepancy. The majority of the studies reviewed in the US Public Health Service guidelines1 use point prevalence as the primary outcome measure; we used continuous abstinence. The guidelines suggest that continuous abstinence underestimates success1 because it does not count as successful those smokers who relapsed and were then abstinent again by follow-up, regardless of NRT use for the latest attempt. Previously, we reported that only 50% of smokers who quit between 3 and 6 months were still abstinent 18 months later.4 Thus, we believe that point prevalence inflates the estimate of success and is not the best measure of either efficacy or effectiveness.
Pierce JP. Effectiveness of Over-the-Counter Nicotine Replacement Therapy—Reply. JAMA. 2002;288(24):3110. doi:10.1001/jama.288.24.3110-JLT1225-1-5