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Smoking cessation - Evidence
Evidence on nicotine replacement therapy

There is substantial evidence to show that nicotine replacement therapy (NRT) is significantly more effective than placebo at maintaining abstinence from cigarette smoking. The different formulations of NRT do not appear to differ in efficacy.

A Cochrane systematic review (search date July 2007) investigated different forms of nicotine replacement therapy (NRT) in achieving total abstinence from cigarettes [Stead et al, 2008]. The review included 132 studies, 111 of which contributed to the primary comparison between NRT and placebo or non-nicotine control. The main findings of the review were:

  • Any form of NRT vs. placebo or non-nicotine control (111 studies, n = 43,040): at maximum follow up (6–12 months), NRT was more effective at maintaining abstinence than placebo or a non-nicotine control (relative risk [RR] 1.58, 95% CI 1.50 to 1.66). The average quit rate with NRT was 17% compared with 10% for placebo.
  • Different forms of NRT vs. placebo or non-nicotine control:
    • Gum (53 studies, n = 19,090): at maximum follow up (6–12 months), NRT gum was more effective at maintaining abstinence than placebo or a non-nicotine control (RR 1.43, 95% CI 1.33 to 1.53).
    • Patch (41 studies, n = 18,237): at maximum follow up (6–12 months), NRT patches were more effective at maintaining abstinence than placebo or a non-nicotine control (RR 1.66, 95% CI 1.53 to 1.81).
    • Intranasal spray (four studies, n = 887): at maximum follow up (6–12 months), NRT spray was more effective at maintaining abstinence than placebo or a non-nicotine control (RR 2.02, 95% CI 1.49 to 3.73).
    • Inhalator (four studies, n = 976): at maximum follow up (6–12 months), NRT inhalator was more effective at maintaining abstinence than placebo or a non-nicotine control (RR 1.90, 95% CI 1.36 to 2.67).
    • Tablet/lozenge (six studies, n = 3109): at maximum follow up (6–12 months), NRT tablets or lozenges were more effective at maintaining abstinence than placebo or a non-nicotine control (RR 2.00, 95% CI 1.63 to 2.45).
  • Direct comparison of different forms of NRT:
    • Inhalator vs. patch (one study, n = 222): at maximum follow up (6–12 months), nicotine inhalator and nicotine patches did not significantly differ at maintaining abstinence (RR 0.59, 95% CI 0.22 to 1.60).
    • Nasal spray vs. patch (two studies, n = 1275): at maximum follow up (6–12 months), nicotine nasal spray and nicotine patches did not significantly differ at maintaining abstinence (RR 0.90, 95% CI 0.64 to 1.27).

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