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