title: A randomized clinical trial of nicotine lozenge for smokeless tobacco use.
abstract: BACKGROUND
  Smokeless tobacco (ST) use is associated with adverse health consequences, and effective treatments are needed. Pilot data suggest that 4-mg nicotine lozenge decreases tobacco craving and nicotine withdrawal symptoms among ST users.
  
  
  METHODS
  We conducted a randomized, placebo-controlled multicenter clinical trial to evaluate the efficacy of 12 weeks of 4-mg nicotine lozenge for ST use.
  
  
  RESULTS
  We randomized 270 participants (136 active lozenge, 134 placebo). No significant differences were observed between the groups in biochemically confirmed all tobacco abstinence rates at Week 12 (36% lozenge vs. 27.6% placebo; odds ratio [OR] 1.5, 95% CI 0.7-2.1; p = .138). However, the 4-mg nicotine lozenge increased self-reported all tobacco abstinence (44.1% vs. 29.1%; OR 1.9, 95% CI 1.2-3.2; p = .011) and self-reported ST abstinence (50.7% vs. 34.3%; OR 2.0, 95% CI 1.2-3.2; p = .013) compared with placebo at the end of treatment (Week 12). Following target quit date (TQD), nicotine withdrawal symptoms decreased significantly with time (time effect = -.022 per day, SE = .003; p < .001) and was significantly lower for the active lozenge (treatment effect = -.213, SE = .071; p = .003). Tobacco craving also decreased significantly following TQD (time effect = -.071, SE = .006; p < .001) and was lower for the active nicotine lozenge (treatment effect = -.452, SE = .164; p = .006).
  
  
  CONCLUSIONS
  The 4-mg nicotine lozenge increased self-reported but not biochemically confirmed tobacco abstinence rates at 3 months. The use of the 4-mg nicotine lozenge is associated with decreased nicotine withdrawal symptoms and tobacco craving.
authors.affiliation: Mayo Clinic College of Medicine; Rochester, MN 55905, USA. ebbert.jon@mayo.edu
authors.forename: Jon O
authors.initials: JO
authors.lastname: Ebbert
authors.forename: Herbert H
authors.initials: HH
authors.lastname: Severson
authors.forename: Ivana T
authors.initials: IT
authors.lastname: Croghan
authors.forename: Brian G
authors.initials: BG
authors.lastname: Danaher
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000339:Affect / Q000187:drug effects; D001288:Attention / Q000187:drug effects; D004304:Dosage Forms; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D018722:Nicotinic Agonists / Q000008:administration & dosage*; D011109:Polymethacrylic Acids / Q000008:administration & dosage*; D011145:Polyvinyls / Q000008:administration & dosage*; D016540:Smoking Cessation / Q000379:methods*; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D004304:Dosage Forms; D018722:Nicotinic Agonists; D011109:Polymethacrylic Acids; D011145:Polyvinyls; D009538:Nicotine