A Cochrane review included 9 studies with a total of 4664 subjects. Combining a nicotine patch with a rapid delivery form (gum, nasal spray, inhaler) of nicotine replacement therapies (NRT) was more effective than a single type of NRT (RR 1.34, 95% CI 1.18 to 1.51; 9 trials, n=4664).
In a RCT a total of 1346 patients (from 12 clinics) attending a routine primary care appointment, were randomly assigned to 5 active pharmacotherapies: 3 monotherapies (nicotine patch, nicotine lozenge, and bupropion hydrochloride sustained release) and 2 combination therapies (patch + lozenge and bupropion + lozenge). Patients were referred to a telephone quit line for cessation counselling. Medication was free. Six-month self-reported abstinence rates were: bupropion 16.8%; lozenge 19.9%; patch 17.7%; patch + lozenge 26.9%; and bupropion + lozenge 29.9%. Combination therapies were clearly superior to all of the monotherapies.
Another Cochrane review included a network meta-analysis of 12 treatment-specific reviews (267 studies) involving 101804 participants. NRT was superior to placebo (odds ratios (OR) 1.84; 95% credible interval (CredI) 1.71 to 1.99, 119 trials). Varenicline was superior to single forms of NRT (OR 1.57; 95% CredI 1.29 to 1.91; indirect comparison), but was not more effective than combination NRT (OR 1.06; 95% CredI 0.75 to 1.48; indirect comparison). Combination NRT also outperformed single formulations. The four categories of NRT performed similarly against each other, apart from 'other' NRT, which was marginally more effective than NRT gum (OR 1.21; 95% CredI 1.01 to 1.46; indirect comparison).
Date of latest search: 16 November 2012