Long-term NRT with support helps smokers to cut down and quit
Prolonged nicotine replacement therapy (NRT) prescribing together with support can be effective in helping smokers to cut down, stop smoking, and to stay stopped, even for those who are not ready to quit straightaway.
In studies of nicotine assisted reduction to stop smoking interventions, patients have the opportunity to take NRT for a prolonged period of up to 18 months, during which they may reduce their cigarette consumption and may make several attempts to quit.
The authors conducted a systematic review of randomised controlled trials of NRT assistance to stop smoking, reviewing both the effectiveness of the intervention, and any associated harm. Published and unpublished work was included in the study, and the authors focused on sustained cessation from smoking as the most clinically relevant outcome measure.
Seven placebo-controlled randomised controlled trials, covering 2,767 smokers from Europe, Australia and the USA, were included in the review. All studies recruited smokers who were unwilling or unable to quit abruptly, and all had reduction in smoking as their primary outcome measure. Four studies used NRT gum, two inhalers, and one allowed free choice of NRT. In addition to NRT, participants received information and advice, ranging from an information booklet in one trial, to regular ‘behavioural support' appointments in others.
In the studies, successful reduction of smoking was common, with 21.8% of NRT participants reducing cigarette consumption by 50%, compared with 16.5% of those given placebo. Sustained reduction from early in treatment to final follow- up was achieved by 6.3% of those on active treatment and 1.6% of those on placebo. The proportion of smokers eventually achieving sustained abstinence for six months with NRT was double that with placebo
(6.75% vs 3.28%, respectively). Nausea was more common in those receiving NRT compared with placebo, but there were no statistically significant differences in adverse events.
Smoking is one of the greatest causes of illness and premature death in the UK, and helping smokers to stop is a crucial part of the GP's role. Only a small proportion of smokers are ready to stop straightaway, and the licence for some NRT preparations has been changed recently to allow more extended prescribing to help smokers reduce smoking, with a view to an eventual attempt at quitting. Longer term NRT prescribing as nicotine assisted reduction to stop can be effective in helping patients to reduce smoking, and in promoting successful quit attempts for others, even for those who are unable to commit to abstinence at the start of treatment.
Moore D, Aveyard P, Connock M. Effectiveness and safety of nicotine replacement therapy assisted reduction to stop smoking: systematic review and meta-analysis. BMJ 2009; 338: b1024Reviewer
Dr Jez Thompson
GP and Clinical Director, NHS Hull Social Inclusion Services