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Cited by 372Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesBehavioral Health and Interventions

Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: systematic review and meta-analysis

Open access
Moore, D., Aveyard, P., Connock, M., Wang, D., Fry-Smith, A., Barton, P.·2009·BMJ
DOI 10.1136/bmj.b1024PMC PMC2664870
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Abstract

OBJECTIVE: To determine the effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking. DESIGN: Systematic review of randomised controlled trials. DATA SOURCES: Cochrane Library, Medline, Embase, CINAHL, PsychINFO, Science Citation Index, registries of ongoing trials, reference lists, the drug company that sponsored most of the trials, and clinical experts. Review methods Eligible studies were published or unpublished randomised controlled trials that enrolled smokers who declared no intention to quit smoking in the short term, and compared nicotine replacement therapy (with or without motivational support) with placebo, no treatment, other pharmacological therapy, or motivational support, and reported quit rates. Two reviewers independently applied eligibility criteria. One reviewer assessed study quality and extracted data and these processes were checked by a second reviewer. The primary outcome, six months sustained abstinence from smoking beginning during treatment, was assessed by individual patient data analysis. Other outcomes were cessation and reduction at end of follow-up, and adverse events. DATA SYNTHESIS: Seven placebo controlled randomised controlled trials were included (four used nicotine replacement therapy gum, two nicotine replacement therapy inhaler, and one free choice of therapy). They were reduction studies that reported smoking cessation as a secondary outcome. The trials enrolled a total of 2767 smokers, gave nicotine replacement therapy for 6-18 months, and lasted 12-26 months. 6.75% of smokers receiving nicotine replacement therapy attained sustained abstinence for six months, twice the rate of those receiving placebo (relative risk (fixed effects) 2.06, 95% confidence interval 1.34 to 3.15; (random effects) 1.99, 1.01 to 3.91; five trials). The number needed to treat was 29. All other cessation and reduction outcomes were significantly more likely in smokers given nicotine replacement therapy than those given placebo. There were no statistically significant differences in adverse events (death, odds ratio 1.00, 95% confidence interval 0.25 to 4.02; serious adverse events, 1.16, 0.79 to 1.50; and discontinuation because of adverse events, 1.25, 0.64 to 2.51) except nausea, which was more common with nicotine replacement therapy (8.7% v 5.3%; odds ratio 1.69, 95% confidence interval 1.21 to 2.36). CONCLUSIONS: Available trials indicate that nicotine replacement therapy is an effective intervention in achieving sustained smoking abstinence for smokers who have no intention or are unable to attempt an abrupt quit. Most of the evidence, however, comes from trials with regular behavioural support and monitoring and it is unclear whether using nicotine replacement therapy without regular contact would be as effective.

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  • There is good evidence from population studies and clinical trials that providing NRT to smokers who cut down their cigarette consumption results in more sustained decreases in cigarette consumption and improves their chances of stopping smoking completely.

    “There is good evidence from both population studies and clinical trials that the provision of NRT to smokers who cut down their cigarette consumption results in more sustained decreases in cigarette consumption and improves their chances of stopping smoking completely.64,65”

    From Evaluating Long-term Outcomes of NHS Stop Smoking Services (ELONS): a prospective cohort study (2015) · cites this paper as [65]

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Research works printed but not linked: 1

  1. [16]Kralikova E, Kozak J, Rasmussen T, Cort N. The clinical benefits of NRT-supported smoking reduction. Nicotine Tob Res 2002; 4: 243.

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Authors
Moore, D., Aveyard, P., Connock, M., Wang, D., Fry-Smith, A., & Barton, P.
Affiliations
University of Birmingham (GB)
Corresponding author
Moore, D.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2009-04-02
Volume
338
Issue
apr02 3
Pages
b1024-b1024
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.b1024
PMC
PMC2664870
OpenAlex
W2010137196
Cited by
372
References
22
Citations by year
2026: 4 · 2025: 5 · 2024: 8 · 2023: 15 · 2022: 16 · 2021: 17 · 2020: 20 · 2019: 27 · 2018: 23 · 2017: 24 · 2016: 25 · 2015: 31 · 2014: 34 · 2013: 37 · 2012: 30
FWCI
3.07
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Funders
Economic and Social Research Council (ES/G007489/1)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords
nicotine replacement therapy, smoking cessation, smoking reduction, nicotine gum, nicotine inhaler, sustained abstinence, adverse events, nausea, motivational support, nicotine dependence, number needed to treat
MeSH terms
Behavior Therapy, Combined Modality Therapy, Female, Humans, Male, Nicotine, Recurrence, Randomized Controlled Trials as Topic, Smoking Cessation, Treatment Outcome, Nicotinic Agonists

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