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Abstract
Aim. This review compared the effect of high-dose nicotine replacement therapy (NRT) and combinations of NRT for increasing smoking abstinence rates compared to standard-dose NRT patch, varenicline, and bupropion on smoking abstinence.
Methods. Ten electronic databases were searched (up to January 2012) for randomized controlled trials (RCT) of standard-dose (≤ 22 mg) or high-dose nicotine patch therapy (> 22 mg), combination NRT (e.g. nicotine patch + nicotine inhaler), bupropion, and varenicline. Analysis consisted of random-effects pairwise meta-analysis and a Bayesian multiple treatment comparison (MTC).
Results. We identified 146 RCTs (65 standard-doses of the nicotine patch (≤ 22 mg); 6 high-dose NRT patch (> 22 mg); 5 high versus standard-dose NRT patch; 5 combination NRT versus inert controls; 6 combination versus single NRT patch; 48 bupropion; and 11 varenicline). The MTC found that all therapies offered treatment benefits at most time points over controls. Combination NRT and higher-dose NRT did not demonstrate consistent effects over other interventions. With the exception of varenicline, the benefits of treatments over standard-dose NRT were not retained in the long term.
Conclusions. All pharmacologic treatments were significantly more effective than inert controls. Varenicline was the only treatment demonstrating effects over other options. These results should be considered in the development of clinical practice guidelines.
Declaration of interest: This study received funding from Pfizer Ltd. Kristian Thorlund receives salary support from the Canadian Institutes of Health Research via the Drug Safety and Effectiveness Network (NETMAN). Edward Mills's salary is provided by the Canadian Institutes of Health Research via a Canada Research Chair.
Ian Lockhart is an employee of Pfizer. Edward Mills, Kristian Thorlund, and Ping Wu have consulted to Pfizer Ltd in previous reports. Jon O. Ebbert has received support to conduct clinical trials with varenicline from Pfizer. Milo A. Puhan reports no conflicts of interest. None of the researchers have any connections with the tobacco, alcohol, gaming industries, or any body substantially funded by one of these organizations.
Notice of Correction
The version of this article published online ahead of print on 6 Aug 2012 contained an error on page 5 Table I and page 6, Figure 2. The heading in the ‘Number of studies’ column read Bupropion versus varenicline but should have read Varenicline versus bupropion. In Figure 2, the numbers didn't add up to what was in the text. The error has been corrected for this version.