Combined Pharmacotherapy and Behavioural Interventions for Smoking Cessation

Summary

A Cochrane review [Abstract] 1 included 53 studies with a total of 25 000 subjects. Most studies provided nicotine replacement therapy (NRT). Behavioural support was typically provided by specialists in cessation counselling includin 4 to 8 sessions. One large study (the Lung Health Study) yielded a substantially larger treatment effect than seen in other studies (RR 3.88, 95% CI 3.35 to 4.50). Since this study used a particularly intensive intervention which included extended availability of nicotine gum, multiple group sessions and long term maintenance and recycling contacts, the results may not be comparable with the interventions used in other studies, and hence it was not pooled in other analyses. The remaining 52 studies showed benefit of combined pharmacotherapy and behavioural treatment compared to usual care, brief advice or less intensive behavioural support (RR 1.83, 95% CI 1.68 to 1.98; n=19488; I² = 36 %; high quality evidence). The pooled estimate for 43 trials that recruited participants in healthcare settings (RR 1.97, 95% CI 1.79 to 2.18) was higher than for 8 trials with community-based recruitment (RR 1.53, 95% CI 1.33 to 1.76).

Another Cochrane review [Abstract] 2 included 10 studies with a total of 3 655 subjects. The medication adherence interventions in addition to standard behavioural support were further information on the rationale for, and emphasised the importance of, adherence to medication or supported the development of strategies to overcome problems with maintaining adherence (or both). The adherence interventions led to small improvements in adherence (i.e. the mean amount of medication consumed; SMD 0.10, 95% CI 0.03 to 0.18; I²=6%; n=3655), limited by risk of bias. There was a very weak indication that interventions focused on the 'practicalities' of adhering to treatment (i.e. capabilities, resources, levels of support or skills) may be effective (SMD 0.21, 95% CI 0.03 to 0.38; I²=39%; n=1752), whereas interventions focused on treatment 'perceptions' (i.e. beliefs, cognitions, concerns and preferences; SMD 0.10, 95% CI -0.03 to 0.24; I²=0%; n=839) or on both (SMD 0.04, 95% CI -0.08 to 0.16; I²=0%; n=1064), may not be effective. Participant-centred interventions were effective (SMD 0.12, 95% CI 0.02 to 0.23; I²=20%; n=2791).

A review and meta-analysis 3 included 19488 smoking subjects. The combination of medication and behavioral counseling was associated with a quit rate of 15.2% over 6 months compared with a quit rate of 8.6% with brief advice or usual care. Brief or intensive behavioral support can be delivered effectively in person or by telephone, text messages, or the internet. The combination of a clinician's brief advice to quit and assistance to obtain tobacco cessation treatment is effective when routinely administered to tobacco users in virtually all health care settings.