Patch or pill? Which is more effective?

• Position: Smoking Cessation

Nearly 70% of smokers who try to quit relapse within one week--daunting odds for people trying to kick the habit. Researchers have long theorized that some individuals may be programmed genetically to have an easier time than others but, with few clues about why, specialists have been unable to guide smokers looking to quit toward a strategy--the nicotine patch versus prescription pills, for instance--with the best opportunity of success.

Now, in a first-of-its-kind randomized clinical trial, researchers from the University of Pennsylvania, Philadelphia, and collaborators have shown that the most-suited treatment for each smoker may depend on how quickly he or she metabolizes the nicotine in his or her body after quitting.

"Normal" metabolizers of nicotine were significantly more likely to stay smoke-free with the help of the drug varenicline, compared to the nicotine patch, at the end of treatment and six months later. "Slow" metabolizers, on the other hand, most likely would benefit from the nicotine patch. Varenicline was just as effective as a nicotine patch at helping those people quit, but there were more overall side effects reported with the drug.

'This is a much-needed, genetically-informed biomarker that could be translated into clinical practice," says lead author Caryn Lerman, professor of psychiatry and director of the Center for Interdisciplinary Research on Nicotine Addiction. "Matching a...