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Evidence summaries

Combination of Varenicline with Nicotine Replacement Therapy for Smoking Cessation

Combining nicotine replacement therapy (NRT) especially NRT patch with varenicline appears to be effective for smoking cessation, and more effective than NRT or varenicline alone. Level of evidence: "B"

The certainty of evidence is downgraded by imprecise results (few patients).

Summary

A systematic review and meta-analysis 1 included 3 RCTs with 904 participants. Combination therapy of varenicline with nicotine replacement therapy (NRT) was better than varenicline alone at 3 months (OR 1.50, 95 % CI 1.14 to 1.97) and at 6 months (OR = 1.62, 95 % CI 1.18 to 2.23). However, this significance diminished after eliminating a study with pre-cessation treatment using nicotine patch.

In another systematic review and network meta-analysis 2 varenicline (standard dose) plus nicotine replacement therapy (standard dose) was ranked first for sustained abstinence (OR 5.75, 95% credible interval 2.27 to 14.90). Higher proportion of smokers who received counselling achieved sustained abstinence than those who did not receive counselling, and higher odds of sustained abstinence among participants with higher average dependence scores. The odds ratios for sustained abstinence wereNRT standard 2.01 (1.68 to 2.41), NRT high 2.32 (1.88 to 2.86), bupropion standard 1.73 (1.43 to 2.10), varenicline standard 2.83 (2.34 to 3.39), bupropion standard plus NRT high 1.99 (0.70 to 5.47), varenicline standard plus bupropion standard 3.25 (1.35 to 7.92).

Clinical comments

Note

Date of latest search: 2022-10-24

References

  • Chang PH, Chiang CH, Ho WC et al. Combination therapy of varenicline with nicotine replacement therapy is better than varenicline alone: a systematic review and meta-analysis of randomized controlled trials. BMC Public Health 2015;15():689. [PubMed]
  • Thomas KH, Dalili MN, López-López JA et al. Smoking cessation medicines and e-cigarettes: a systematic review, network meta-analysis and cost-effectiveness analysis. Health Technol Assess 2021;25(59):1-224. [PubMed]

Primary/Secondary Keywords