Sir,
T Sivasankari et al. did a study titled “Comparative evaluation of the efficacy of nicotine chewing gum and nicotine patches as nicotine replacement therapy using salivary cotinine levels as a biochemical validation measure” which was published in the Indian Journal of Psychiatry volume 65, Issue 6 on June 2023 in pages 635–640. The cross-sectional study was done by dividing known smokers into two groups, wherein one group was offered nicotine patch and the other group was offered nicotine chewing gum for a period of 12 weeks.[1] The saliva samples collected at baseline and at the end of 12 weeks yielded pre and postcotinine estimation through which the efficacy of nicotine replacement therapy (NRT) and comparison of the efficacy of both types of NRT was performed. The study findings are interesting and relevant; however, there are a few concerns we would like to bring to the attention of this scientific forum.
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(1)
There is a discrepancy in the sample size mentioned in the abstract as 72; however, in the methodology section of the manuscript, it is mentioned as 56.
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(2)
How the participants were randomized into two groups is not clearly mentioned in the study.
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(3)
The NRT for patients smoking 10–19 cigarettes in the group treated with nicotine patches was mentioned for a total of 8 weeks compared to the 12-week regimen planned for all the patients. Also, for the patients in the nicotine gum group, the time period of intervention was mentioned as 6–12 weeks rather than a 12-week regimen for the nicotine patch group.[2] Furthermore, it is not explained why 21-mg patch was not administered to patients smoking more than 20 cigarettes per day.[3]
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(4)
Information regarding how the compliance by patients was ensured is not clear.
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(5)
The Fagerstrom Test for Nicotine Dependence scores for high dependence was mentioned as 0–2 and for moderate dependence as 3–4 in the discussion part, which needs clarification.
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(6)
We would also like to know if any medical intervention like bupropion or varenicline was given to any of the patients.
The readers would benefit from the clarification of the authors through your good self. It would increase the value of the study by making things more clear.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Sivasankari T, Sankaran A, Murugappan S, Subramanyam V, Subramanian B, Reddy RJ, et al. Comparative evaluation of the efficacy of nicotine chewing gum and nicotine patches as nicotine replacement therapy using salivary cotinine levels as a biochemical validation measure. Indian J Psychiatry. 2023;65:635–40. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_291_23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Lindson N, Chepkin SC, Ye W, Fanshawe TR, Bullen C, Hartmann-Boyce J. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2019;4:CD013308. doi: 10.1002/14651858.CD013308. doi: 10.1002/14651858.CD013308. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Taylor DM, Barnes TRE, Young AH. 14th. John Wiley and Sons; 2021. The Maudsley Prescribing Guidelines in Psychiatry; p. 504. [Google Scholar]