Clinical question
How effective are different forms, deliveries, doses, durations and schedules of nicotine replacement therapy, for achieving long‐term smoking cessation, compared with one another?
Bottom line
Combination NRT (fast‐acting form plus patch) resulted in approximately 15% to 36% higher long‐term quit rates than a single form of NRT. Nicotine gum (4mg) resulted in approximately 12% to 83% higher quit rates than nicotine gum (2mg), although there was some evidence to suggest this might vary based on nicotine dependence. Forms of fast‐acting NRT, such as gum and lozenge, were as effective a cessation aid as nicotine patches. There was some evidence that using NRT before a quit day could result in higher quit rates than beginning NRT on a quit day. Studies lasted for at least 6 months. Evidence for the comparative safety and tolerability of different types of NRT use was of low and very low certainty.
Caveat
These conclusions applied to smokers who were motivated to quit and who smoked approximately 15 or more cigarettes a day.
Context
NRT aims to replace nicotine from cigarettes, to ease the transition from cigarette smoking to abstinence. 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.
Cochrane Systematic Review
Lindson N et al. Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Reviews, 2019, Issue 4. Art. No.: CD013308.DOI: 10.1002/14651858.CD013308. This review contains 63 studies involving 41,509 participants.
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