Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation

Abstract

Background Nicotine replacement therapy (NRT) aims to replace nicotine from cigarettes. This helps to reduce cravings and withdrawal symptoms, and ease the transition from cigarette smoking to complete abstinence. Although there is high‐certainty evidence that NRT is effective for achieving long‐term smoking abstinence, it is unclear whether different forms, doses, durations of treatment or timing of use impacts its effects. Objectives To determine the effectiveness and safety of different forms, deliveries, doses, durations and schedules of NRT, for achieving long‐term smoking cessation. Search methods We searched the Cochrane Tobacco Addiction Group trials register for papers mentioning NRT in the title, abstract or keywords, most recently in April 2022. Selection criteria We included randomised trials in people motivated to quit, comparing one type of NRT use with another. We excluded studies that did not assess cessation as an outcome, with follow‐up of fewer than six months, and with additional intervention components not matched between arms. Separate reviews cover studies comparing NRT to control, or to other pharmacotherapies. Data collection and analysis We followed standard Cochrane methods. We measured smoking abstinence after at least six months, using the most rigorous definition available. We extracted data on cardiac adverse events (AEs), serious adverse events (SAEs) and study withdrawals due to treatment. Main results We identified 68 completed studies with 43,327 participants, five of which are new to this update. Most completed studies recruited adults either from the community or from healthcare clinics. We judged 28 of the 68 studies to be at high risk of bias. Restricting the analysis only to those studies at low or unclear risk of bias did not significantly alter results for any comparisons apart from the preloading comparison, which tested the effect of using NRT prior to quit day whilst still smoking. There is high‐certainty evidence that combination NRT (fast‐acting form plus patch) results in higher long‐term quit rates than single form (risk ratio (RR) 1.27, 95% confidence interval (CI) 1.17 to 1.37; I 2 = 12%; 16 studies, 12,169 participants). Moderate‐certainty evidence, limited by imprecision, indicates that 42/44 mg patches are as effective as 21/22 mg (24‐hour) patches (RR 1.09, 95% CI 0.93 to 1.29; I 2 = 38%; 5 studies, 1655 participants), and that 21 mg patches are more effective than 14 mg (24‐hour) patches (RR 1.48, 95% CI 1.06 to 2.08; 1 study, 537 participants). Moderate‐certainty evidence, again limited by imprecision, also suggests a benefit of 25 mg over 15 mg (16‐hour) patches, but the lower limit of the CI encompassed no difference (RR 1.19, 95% CI 1.00 to 1.41; I 2 = 0%; 3 studies, 3446 participants...

RETRACTED: Efficacy of Electronic Cigarettes vs Varenicline and Nicotine Chewing Gum as an Aid to Stop Smoking

“…The trial used a single NRT product as a comparator. A combination of NRT products is more effective than single NRT, and a trial that compared ECs with combination NRT reported a lower effect size at 6 months (RR, 1.36; 95% CI, 1.15- 2.6.9) than found in the current study. The finding that EC had similar efficacy to varenicline corresponded with a previous finding showing varenicline as superior to NRT, with a difference in efficacy similar to that found between EC and NRT …”

Oxidative stress and inflammation: elucidating mechanisms of smoking-attributable pathology for therapeutic targeting

“…Nicotine replacement therapy (NRT) through gum, lozenges, patches, sprays and inhalers doubles long-term quit rates compared to placebo. The choice of NRT format can be tailored to individual needs and preferences (Theodoulou et al 2023a). Beyond nicotine delivery, the antidepressant bupropion and the nicotinic receptor partial agonist varenicline also improve cessation outcomes.…”

“…E-cigarettes aim to provide users with inhaled nicotine and smoking-related sensory cues while eliminating toxic combustion products responsible for the majority of smoking-related disease risks. This has led to considerable interest in evaluating whether e-cigarettes may represent a reduced harm nicotine product that can effectively promote smoking cessation (Theodoulou et al 2023b).…”

Assessing the feasibility and acceptability of a diabetes-specific nurse-led multicomponent smoking cessation intervention in diabetes education: study protocol for an open-label pragmatic randomised controlled trial

“…In line with standard smoking cessation research practice, 65 86 87 intention-to-treat analysis will be used for assessing effectiveness. Participants with missing smoking outcome data, that is, those who drop out of the study or who are lost to follow-up, and participants whose abstinence cannot be biochemically verified, will be considered as continuing smokers or to have resumed smoking.…”