Combination nicotine replacement therapy better than single form

Background: NRT use after smoking cessation helps smokers transition to abstinence by reducing the intensity of craving and withdrawal symptoms. It is uncertain which forms of NRTs are more likely to result in long-term smoking cessation.

Study design: Meta-analysis.

Setting: Cochrane review of randomized trials.

Synopsis: In this Cochrane Review, the authors identified 63 randomized trials with 41,509 participants comparing one type of NRT with another.

Combination NRT (for example, the patch & a fast-acting form such as gum or lozenge) increases long-term quit rates versus single-form NRT (risk ratio, 1.25; 95% confidence interval, 1.15-1.36). Researchers compared 4 mg to 2 mg nicotine gum and found a benefit of the higher dose (RR, 1.43; 95% CI, 1.12-1.83), although possibly only among heavy users.

Bottom line: Prescribe combination patch and short-acting NRTs to smokers motivated to quit.

Citation: Lindson N et al. Different doses, durations, and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2019 Apr 18;4:CD013308. doi: 10.1002/14651858.CD013308.

Dr. Miller is a hospitalist at the University of Colorado at Denver, Aurora.

Background: NRT use after smoking cessation helps smokers transition to abstinence by reducing the intensity of craving and withdrawal symptoms. It is uncertain which forms of NRTs are more likely to result in long-term smoking cessation.

Study design: Meta-analysis.

Setting: Cochrane review of randomized trials.

Synopsis: In this Cochrane Review, the authors identified 63 randomized trials with 41,509 participants comparing one type of NRT with another.

Combination NRT (for example, the patch & a fast-acting form such as gum or lozenge) increases long-term quit rates versus single-form NRT (risk ratio, 1.25; 95% confidence interval, 1.15-1.36). Researchers compared 4 mg to 2 mg nicotine gum and found a benefit of the higher dose (RR, 1.43; 95% CI, 1.12-1.83), although possibly only among heavy users.

Bottom line: Prescribe combination patch and short-acting NRTs to smokers motivated to quit.

Citation: Lindson N et al. Different doses, durations, and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2019 Apr 18;4:CD013308. doi: 10.1002/14651858.CD013308.

Dr. Miller is a hospitalist at the University of Colorado at Denver, Aurora.

Background: NRT use after smoking cessation helps smokers transition to abstinence by reducing the intensity of craving and withdrawal symptoms. It is uncertain which forms of NRTs are more likely to result in long-term smoking cessation.

Study design: Meta-analysis.

Setting: Cochrane review of randomized trials.

Synopsis: In this Cochrane Review, the authors identified 63 randomized trials with 41,509 participants comparing one type of NRT with another.

Combination NRT (for example, the patch & a fast-acting form such as gum or lozenge) increases long-term quit rates versus single-form NRT (risk ratio, 1.25; 95% confidence interval, 1.15-1.36). Researchers compared 4 mg to 2 mg nicotine gum and found a benefit of the higher dose (RR, 1.43; 95% CI, 1.12-1.83), although possibly only among heavy users.

Bottom line: Prescribe combination patch and short-acting NRTs to smokers motivated to quit.

Citation: Lindson N et al. Different doses, durations, and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2019 Apr 18;4:CD013308. doi: 10.1002/14651858.CD013308.

Dr. Miller is a hospitalist at the University of Colorado at Denver, Aurora.