What is the efficacy of nicotine replacement therapy (NRT) for the treatment of nicotine addiction?

Updated: Jul 16, 2018
  • Author: R Gregory Lande, DO, FACN; Chief Editor: Glen L Xiong, MD  more...
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In a Cochrane meta-analysis of 132 trials involving the use of any type of NRT along with a placebo or non-NRT control group, the risk ratio (RR) of abstinence for any form of NRT relative to control was 1.58 (95% confidence interval [CI], 1.50-1.66). [3] The pooled RRs for each type were as follows:

  • 1.43 (95% CI, 1.33 to 1.53; 53 trials) for nicotine gum

  • 1.66 (95% CI, 1.53-1.81; 41 trials) for the transdermal nicotine patch

  • 1.90 (95% CI, 1.36-2.67; 4 trials) for the nicotine inhaler

  • 2.00 (95% CI, 1.63-2.45; 6 trials) for oral tablets or lozenges

  • 2.02 (95% CI, 1.49-3.73, 4 trials) for the nicotine nasal spray

Thus, all of the commercially available forms of NRT increase the chances of successful smoking cessation. Overall, NRT increases the quit rate by 50-70%, and the increase appears to be independent of any additional support provided.

Piper et al conducted a randomized, placebo-controlled, double-blind trial of 5 smoking cessation pharmacotherapies. [40] The study population included 1504 adults who smoked at least 10 cigarettes daily for the previous 6 months and were motivated to quit smoking. Patients were randomly assigned to 1 of the following groups: nicotine lozenge, nicotine patch, sustained-release bupropion, nicotine patch plus nicotine lozenge, bupropion plus nicotine lozenge, or placebo.

All treatment groups had smoking cessation rates differing from those of the placebo group, but only the nicotine patch–plus–nicotine lozenge group showed significantly higher abstinence rates at 6 months after quitting in comparison with the placebo group. [40] The effects of the nicotine lozenge, bupropion, and bupropion plus lozenge were comparable with those reported in previous research.

A Canadian study, purported to be the first population-based longitudinal study using a representative sample of smokers, examined the association between duration of NRT use and smoking cessation (≥1 month). Results of the study support the recommendation to use NRT, particularly the patch, for 8–12 weeks in the clinical practice guideline by the US Public Health Service. [41, 4]

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