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NRT combination ‘as effective as varenicline’

Combination treatment with nicotine-replacement therapy is as effective as monotherapy with varenicline, according to a gold-standard meta-analysis.

The study
Researchers from the Cochrane Collaboration selected at 12 Cochrane reviews on 26 smoking cessation pharmacotherapies, from 2008 to 2012, analysing 267 trials and more than 101,000 smokers. The most common pharmacological interventions were nicotine replacement therapy (NRT), bupropion and varenicline. The primary meta-analysis aimed to identify the efficacy of NRT, bupropion and varenicline compared to placebo and to each other and whether they achieved long term abstinence (six months and longer).

The findings
NRT, bupropion and varenicline were all more effective than placebo - with varenicline showing the most marked efficacy, with an odds ratio (OR) of 2.88, compared with placebo. There was no significant difference between buproprion and NRT when compared against each other (OR of 0.99). However, varenicline had superior efficacy to both NRT (OR 1.57) and to bupropion (OR 1.59).

Individuals on varenicline had better changes of quitting than on the NRT patch (OR 1.51), or NRT gum (1.72) or when compared with other types of NRT (OR 1.42), but combination NRT was as effective as varenicline (OR 1.06). The different types of NRT were equally effective with combination NRT more effective than single NRT. Bupropion combined with NRT did not show better efficacy than NRT alone (RR 1.23).

What this means for to GPs

The authors concluded: ‘Combination use of NRT is as effective as varenicline, and more effective than single types of NRT’. But they added that ‘continued monitoring’ of the safety of varenicline was needed as data was lacking.

Cochrane Library 2013, online 31 May

Readers' comments (1)

  • Vinci Ho

    I do believe combination NRT is a better option than patches alone but we need a guidance for the actual logistics of choosing different products . A bit like the NICE pathway on inhalers in COPD , for instance.
    Problem is product like e-cigarette has got no evidence on safety and efficacy .
    As I said before in the article about combination NRT in pregnancy , the slightest concern is nicotine toxicity .

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