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Cited by 254Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesPrenatal Substance Exposure Effects

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

Open access
Lindson, Nicola, Chepkin, Samantha C, Ye, Weiyu, Fanshawe, Thomas R, Bullen, Chris, Hartmann-Boyce, Jamie·2019·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd013308PMC PMC6470854
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Abstract

BACKGROUND: Nicotine replacement therapy (NRT) aims to replace nicotine from cigarettes to ease the transition from cigarette smoking to abstinence. It works by reducing the intensity of craving and withdrawal symptoms. Although there is clear evidence that NRT used after smoking cessation is effective, it is unclear whether higher doses, longer durations of treatment, or using NRT before cessation add to its effectiveness. OBJECTIVES: To determine the effectiveness and safety of different forms, deliveries, doses, durations and schedules of NRT, for achieving long-term smoking cessation, compared to one another. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group trials register, and trial registries for papers mentioning NRT in the title, abstract or keywords. Date of most recent search: April 2018. SELECTION CRITERIA: Randomized trials in people motivated to quit, comparing one type of NRT use with another. We excluded trials that did not assess cessation as an outcome, with follow-up less than six months, and with additional intervention components not matched between arms. Trials comparing NRT to control, and trials comparing NRT to other pharmacotherapies, are covered elsewhere. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods. Smoking abstinence was measured 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. We calculated the risk ratio (RR) and the 95% confidence interval (CI) for each outcome for each study, where possible. We grouped eligible studies according to the type of comparison. We carried out meta-analyses where appropriate, using a Mantel-Haenszel fixed-effect model. MAIN RESULTS: = 0%; low certainty). AUTHORS' CONCLUSIONS: There is high-certainty evidence that using combination NRT versus single-form NRT, and 4 mg versus 2 mg nicotine gum, can increase the chances of successfully stopping smoking. For patch dose comparisons, evidence was of moderate certainty, due to imprecision. Twenty-one mg patches resulted in higher quit rates than 14 mg (24-hour) patches, and using 25 mg patches resulted in higher quit rates than using 15 mg (16-hour) patches, although in the latter case the CI included one. There was no clear evidence of superiority for 42/44 mg over 21/22 mg (24-hour) patches. Using a fast-acting form of NRT, such as gum or lozenge, resulted in similar quit rates to nicotine patches. There is moderate-certainty evidence that using NRT prior to quitting may improve quit rates versus using it from quit date only; however, further research is needed to ensure the robustness of this finding. Evidence for the comparative safety and tolerability of different types of NRT use is of low and very low certainty. New studies should ensure that AEs, SAEs and withdrawals due to treatment are both measured and reported.

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  • Combined NRT (typically a long- and short-acting therapy) was associated with quitting at 6 months or more compared with a single form of NRT (RR 1.25 [95% CI, 1.15 to 1.36]; 14 trials; n=11,356).

    “There was also an association between combined NRT (typically a long- and short-acting therapy) showed a and quitting at 6 months or more (RR 1.25 [95% CI, 1.15 to 1.36]; 14 trials; n=11,356) compared with a single form of NRT.[35](#R35)”

    From Interventions for Tobacco Cessation in Adults, Including Pregnant Persons (2021) · cites this paper as [35]

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3 of the 203 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Deeks J, Higgins JP, Altman DG, (editors) on behalf of the Cochrane Statistical Methods Group. Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JP, Churchill R, Chandler J, Cumpston MS, editor(s), Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017), Cochrane, 2017. Available from www.training.cochrane.org/handbook.
  2. Osservatorio Fumo, Alcol e Droga. Linee Guida Cliniche per Promuovere la Cessazione dell'Abitudine al Fumo. Rome: Istituto Superiore di Sanita, 2004. References to other published versions of this review
  3. Silagy C, Lancaster T, Stead L, Mant D, Fowler G. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2001, Issue 3. [DOI: 10.1002/14651858.CD000146] · DOI · Paper page
  4. Silagy C, Lancaster T, Stead L, Mant D, Fowler G. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2002, Issue 4. [DOI: 10.1002/14651858.CD000146] · DOI · Paper page

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Authors
Lindson, N., Chepkin, S. C., Ye, W., Fanshawe, T. R., Bullen, C., & Hartmann-Boyce, J.
Affiliations
  • University of Oxford (GB)
  • Cochrane (GB)
  • University of Auckland (NZ)
  • University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford Oxfordshire UK OX2 6GG
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2019-04-18
Volume
2019
Issue
4
Pages
CD013308-CD013308
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd013308
PMC
PMC6470854
OpenAlex
W2939123026
Cited by
254
References
203
Citations by year
2026: 7 · 2025: 30 · 2024: 32 · 2023: 50 · 2022: 39 · 2021: 55 · 2020: 22 · 2019: 18 · 2012: 1
FWCI
3.95
Type
journal article
Language
en
Update notices
new_version (2023-06-19)
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › 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 lozenges, nicotine dose, treatment duration, long-term abstinence, adverse events, adverse cardiac events, serious adverse events, treatment withdrawal, nicotine withdrawal symptoms, nicotine craving, harm reduction
MeSH terms
Smoking Prevention, Administration, Cutaneous, Administration, Inhalation, Administration, Oral, Chewing Gum, Humans, Nicotine, Smoking, Randomized Controlled Trials as Topic, Smoking Cessation, Nicotinic Agonists, Tobacco Use Cessation Devices

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