CoChat
Sign Up
Cited by 972Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesPrenatal Substance Exposure Effects

The DOI matches its Crossref record; 223 of the 223 references it cites were found in a registry or an index.

Nicotine replacement therapy for smoking cessation

Silagy, C, Lancaster, T, Stead, L, Mant, D, Fowler, G·2004·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd000146.pub2
Open this paper in CoChat — free account

Abstract

BACKGROUND: The aim of nicotine replacement therapy (NRT) is to replace nicotine from cigarettes. This reduces withdrawal symptoms associated with smoking cessation to help resist the urge to smoke cigarettes. OBJECTIVES: The aims of this review were to determine the effectiveness of the different forms of nicotine replacement therapy (chewing gum, transdermal patches, nasal spray, inhalers and tablets) in achieving abstinence from cigarettes; to determine whether the effect is influenced by the clinical setting in which the smoker is recruited and treated, the dosage and form of the NRT used, or the intensity of additional advice and support offered to the smoker; and to determine whether combinations of NRT are more effective than one type alone. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register. SELECTION CRITERIA: Randomized trials in which NRT was compared to placebo or no treatment, or where different doses of NRT were compared. We excluded trials which did not report cessation rates, and those with follow-up of less than six months. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the type of subjects, the dose and duration and form of nicotine therapy, the outcome measures, method of randomisation, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where appropriate, we performed meta-analysis using a fixed effects model. MAIN RESULTS: We identified 49 trials of nicotine gum, 32 of transdermal nicotine patch, four of intranasal nicotine spray, four of inhaled nicotine and two of nicotine sublingual tablet. Three trials compared combinations of two forms of nicotine therapy with one form alone. The odds ratio for abstinence with NRT compared to control was 1.72 (95% confidence interval 1.60 to 1.84), The odds ratios for the different forms of NRT were 1.63 for gum, 1.77 for patches, 2.27 for nasal spray, 2.08 for inhaled nicotine and 1.73 for nicotine sublingual tablet. These odds were largely independent of the intensity of additional support provided or the setting in which the NRT was offered. Eight weeks of patch therapy was as effective as longer courses and there was no evidence that tapered therapy was better than abrupt withdrawal. Wearing the patch only during waking hours (16 hours/day) was as effective as wearing it for 24 hours/day. The odds ratio for abstinence in the trials which directly compared 4 mg versus 2 mg gum in highly dependent smokers found a significant benefit in favour of 4 mg gum (odds ratio 2.67, 95% confidence interval 1.69 to 4.22). There is no strong evidence that combinations of forms of NRT are more effective. Only one study directly compared NRT against another pharmacotherapy (bupropion) and found that the latter was significantly more effective either alone or used in combination with nicotine patch than if nicotine patch was used alone. REVIEWER'S CONCLUSIONS: All of the commercially available forms of NRT (nicotine gum, transdermal patch, and in some countries, the nicotine nasal spray, nicotine inhaler and nicotine sublingual tablets) are effective as part of a strategy to promote smoking cessation. They increase quit rates approximately 1.5 to 2 fold regardless of setting. The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the smoker. Since all the trials of NRT reported so far have included at least some form of brief advice to the smoker, this represents the minimum which should be offered in order to ensure its effectiveness. Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT. There is promising evidence that bupropion may be more effective than NRT (either alone or in combination). (ABSTRACT

Overview

Integrity signals

Registry

Crossref · 10.1002/14651858.cd000146.pub2

Cites

223 of 223 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Verification

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Citations

Cites

Flagged first, then by citations

Show all 213 references

Research works printed but not linked: 33

  1. Blondal, 1993, Controlled trial of nicotine nasal spray as an aid to stopping smoking [abstract], European Respiratory Journal, 6 Suppl 17, 631S
  2. Bohandana, 1999, Nicotine inhaler and nicotine patch: a combination therapy for smoking cessation [abstract], Nicotine & Tobacco Research, 1, 189
  3. Campbell, 1987, Do nicotine chewing-gum and postal encouragement add to doctors' advice, Practitioner, 231, 114
  4. Campbell, 1992, Nicotine patches v placebo in 234 hospital patients, Thorax, 45, 835
  5. Croghan, 1998, Comparison of a 15 mg transdermal nicotine patch alone versus nicotine nasal spray alone versus both for smoking cessation, Journal of Addictive Diseases, 17, 121
  6. Dautzenberg, 2001, First demonstration of the good efficacy/safety ratio of Nicotinell(r) 1mg Lozenge (NL 1mg), a new form of nicotine substitution, by randomised clinical trial, European Respiratory Journal, 18 Suppl 33, 12s
  7. Abelin, 1991, Clinical experience with a transdermal nicotine system in healthy nicotine-dependent smokers, 35
  8. Abelin, 1989, Effectiveness of a transdermal nicotine system in smoking cessation studies, Methods and Findings in Experimental and Clinical Pharmacology, 11, 205
  9. Fiore, 1994, Two studies of the clinical effectiveness of the nicotine patch with different counseling treatments, Chest, 105, 524, 10.1378/chest.105.2.524 · DOI
  10. Quilez Garcia, 1993, Treatment for smoking with nicotine gum in primary care. A double blind trial, Revista Clinica Espanol, 192, 157
  11. Hays, 1997, Over-the-Counter (OTC) transdermal nicotine patch therapy [abstract], Journal of Addictive Diseases, 16, 136
  12. Hays JT Croghan IT Offord KP Hurt RD Schroeder DR Wolter TD Over the counter 22mg nicotine patch therapy for smoking cessation: results from randomized double-blind placebo-controlled and open label trials Society for Research on Nicotine and Tobacco: 5th Annual Meeting; San Diego (CA) 1999 · DOI
  13. Killen, 1997, Nicotine patch and self-help video for cigarette smoking cessation, Journal of Consulting and Clinical Psychology, 65, 663, 10.1037/0022-006X.65.4.663 · DOI
  14. Leischow, 1996, Efficacy of the nicotine inhaler as an adjunct to smoking cessation, American Journal of Health Behavior, 20, 364
  15. Mori T Shimao T Yulchiro G Namiki M Hyachi T A clinical trial of nicotine chewing gum for smoking cessation [abstract 428] 8th World Conference on Tobacco or Health; Buenos Aires, Argentina 1992
  16. Perng, 1999, Randomized, double-blind, placebo-controlled study of transdermal nicotine patch for smoking cessation, American Journal of Respiratory and Critical Care Medicine, 159, A735
  17. Richmond, 1997, Effectiveness of a 24-hour transdermal nicotine patch in conjunction with a cognitive behavioural programme: One year outcome, Addiction, 92, 27
  18. Roto, 1987, Nicotine gum and withdrawal from smoking, Suomen Laakarllehtl, 36, 3445
  19. Shiffman, 2002, Efficacy of a nicotine lozenge for smoking cessation, Archives of Internal Medicine, 162, 1267, 10.1001/archinte.162.11.1267 · DOI · Paper page
  20. Mikkelsen, 1994, Three-year outcome of two- and three-year sustained abstainers from a smoking cessation study with nicotine patches, Journal of Smoking-Related Disorders, 5, 95
  21. Tonnesen, 1992, Two-year outcome in a smoking cessation trial with a nicotine patch, Journal of Smoking-Related Disorders, 3, 241
  22. Villa, 1999, Effectiveness of a multicomponent program to quit smoking with and without nicotine chewing gum, Psicologia Conductual, 7, 107
  23. Pharmacia, 1998, Nicorette Nicotine Microtab Monograph, Adis Internatio
  24. Kozak, 1995, High-dose treatment with the nicotine patch, International Journal of Smoking Cessation, 4, 26
  25. Krumpe, 1989, Efficacy of transdermal nicotine administration as an adjunct for smoking cessation in heavily nicotine addicted smokers, Annual Review of Respiratory Disease, 139, A337
  26. Meier Lammermann, 1990, Combination of transdermal nicotine substitution and behavioural group therapy in smoking cessation, European Respiratory Journal, 3 suppl 10, 168S
  27. Sutherland, 1999, A placebo-controlled double-blind combination trial of nicotine spray and patch [abstract], Nicotine & Tobacco Research, 1, 186
  28. Deeks J Higgins JPT Altman DG Analysing and presenting results: in Cochrane Reviewers' Handbook 4.2.1. [updated December 2003]: Section 8 Alderson P Green S Higgins J The Cochrane Library, Issue i, 2004 (www.cochrane.org/resources/handbook/hbook.htm) Chichester John Wiley & Sons, Ltd
  29. Fiore, 2000, Treating Tobacco Use and Dependence. A Clinical Practice Guideline
  30. Rothman, 1986, Modern Epidemiology
  31. Saul, 1993, Chancing your arm on nicotine patches, New Scientist, 137, 12
  32. 1994, Nicotine replacement therapy for patients with coronary artery disease. Working Group for the Study of Transdermal Nicotine in Patients with Coronary Artery Disease, Archives of Internal Medicine, 154, 989, 10.1001/archinte.1994.00420090063007 · DOI
  33. Silagy, 1994, The effectiveness of nicotine replacement therapies in smoking cessation, Online Journal of Current Clinical Trials, Doc No 113

Cited by

Sorted by citations

Items 501–600 of 969

Related

See all

Metadata

Authors
Silagy, C., Lancaster, T., Stead, L., Mant, D., & Fowler, G.
Affiliations
  • Monash Medical Centre (AU)
  • University of Oxford (GB)
  • Primary Health Care (QA)
Venue
Cochrane Database of Systematic Reviews
Publisher
John Wiley & Sons, Ltd
Published
2004-07-19
Volume
90
Issue
2
Pages
CD000146-CD000146
ISSN
1361-6137 (ISSN-L)
DOI
10.1002/14651858.cd000146.pub2
OpenAlex
W2463861392
Cited by
972
References
213
Citations by year
2026: 2 · 2025: 4 · 2024: 6 · 2023: 14 · 2022: 13 · 2021: 8 · 2020: 20 · 2019: 11 · 2018: 21 · 2017: 18 · 2016: 18 · 2015: 28 · 2014: 21 · 2013: 23 · 2012: 48
Type
reference entry
Language
en
Open access
closed
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
Keywords
nicotine replacement therapy, smoking cessation, nicotine gum, nicotine patch, nicotine nasal spray, nicotine inhaler, smoking abstinence, nicotine dependence, nicotine withdrawal symptoms, tobacco control, tobacco advertising restrictions, tobacco control legislation, tobacco control enforcement
MeSH terms
Smoking Prevention, Administration, Cutaneous, Humans, Nicotine, Smoking Cessation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review