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

The DOI matches its Crossref record; 200 of the 203 references it cites were found in a registry or an index.

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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  2. Bohadana, 1999, Nicotine inhaler and nicotine patch: a combination therapy for smoking cessation, Nicotine & Tobacco Research, 1, 189
  3. 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
  4. Hays, 1997, Over-the-counter (OTC) transdermal nicotine patch therapy, Journal of Addictive Diseases, 16, 136
  5. Kornitzer, 1993, Efficiency and safety of combined use of nicotine patches and nicotine gum in smoking cessation: a placebo controlled double-blind trial, European Respiratory Journal, 6, 630S
  6. Rose, 1996, Nicotine/mecamylamine combination treatment for smoking cessation [published erratum appears in Drug Development Research 1997;40:215], Drug Development Research, 38, 243, 10.1002/(SICI)1098-2299(199607/08)38:3/4<243::AID-DDR13>3.0.CO;2-# · DOI
  7. Rose, 2011, Nicotine preloading: The importance of a pre-cessation reduction in smoking behavior, Psychopharmacology, 217, 453, 10.1007/s00213-011-2350-0 · DOI
  8. Haustein, 2003, The effect of short-term or long-term reduction on smoking cessation; results from a placebo controlled smoking reduction study with the nicotine gum, Nicotine & Tobacco Research, 5, 278
  9. Kozak, 1995, High-dose treatment with the nicotine patch, International Journal of Smoking Cessation, 4, 26
  10. Landfeldt, 1998, Nicotine replacement treatment in heavy smokers: nicotine nasal spray combined with nicotine patch in a double-blind controlled study, European Respiratory Journal, 12, 154S
  11. Sutherland, 1999, A placebo-controlled double-blind combination trial of nicotine spray and patch, Nicotine & Tobacco Research, 1, 186
  12. Vikhireva O Shalnova S Deev A Nicotine replacement therapy in Russia: old wine in new skins? Randomized parallel study of nicotine gum/inhaler in smoking cessation/reduction Society for Research on Nicotine and Tobacco. Fifth European Conference. 2003 11 20-22, Padua, Italy 2003
  13. Leblanc, 2017, STEP-ing up smoking cessation: weight-related concern of participants who want to quit smoking, Obesity Facts, 10, 207
  14. Joint Formulary Committee, 2018, British National Formulary
  15. 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
  16. Osservatorio, 2004, Linee Guida Cliniche per Promuovere la Cessazione dell’Abitudine al Fumo
  17. Silagy, 1996, Nicotine replacement therapy for smoking cessation, Cochrane Database of Systematic Reviews
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Metadata

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
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 › 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 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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