Combined nicotine therapy more effective in stopping smoking, study shows
AUCKLAND: Smokers would have a better chance of quitting the habit if they used nicotine gum and patches at the same time, rather than just one or the other.
A new systemic review, coauthored by a University of Auckland researcher, also found starting nicotine replacement therapy (NRT) a week or two before trying to quit smoking could also help — although more evidence was needed.
NRT is available as longacting skin patches, and shortacting chewing gum, nasal and oral sprays, inhalers, lozenges and tablets that deliver nicotine through the body to the brain.
In New Zealand and many other countries, people can get NRT from healthcare professionals as well as over the counter, without prescriptions.
The aim of NRT was to replace the nicotine that people who smoke usually get from cigarettes, so the urge to smoke was reduced and they could stop smoking altogether.
The new Cochrane review covered 63 clinical trials with a total of 41,509 participants, who typically smoked at least 15 cigarettes a day at the start of the study.
The review authors found that just over 17% of people who combined a patch with another type of NRT were able to quit for six months or longer, compared with about 14% of people who used a single type.
People were also more likely to successfully quit if they used higherdose nicotine gum, containing 4mg of nicotine, in comparison to lowerdose nicotine gum, containing 2mg of nicotine.
Higherdose nicotine patches — containing 25mg or 21mg of nicotine — probably made it more likely that a person would quit smoking than lowerdose nicotine patches containing 15mg or 14mg.
All studies were conducted in people who wanted to quit smoking, and most were conducted in adults.
‘‘The review shows a clear advantage of using a combination of a longacting and shortacting NRT compared with single therapy alone,’’ Prof Chris Bullen, of the university’s School of Population Health, said.
‘‘Importantly, the Cochrane review found no evidence that using two NRT products together increases the risk of harms, which are rare and minor — such as skin irritation from patches, or mouth ulcers from lozenges.’’
Prof Bullen said the guidelines in New Zealand lined up with these latest findings.
‘‘But one potential barrier to smokers wanting to use combined NRT is that you have to pay a separate pharmacy dispensing fee for each type. That’s something worth reviewing on the basis of this evidence.
‘‘However, if people go to their local ‘stop smoking’ provider, they can get NRT products free.
The review’s lead author, Dr Nicola Lindson from the Nuffield Department of Primary Care Health Sciences at the University of Oxford in the UK, said the researchers tried to answer other important questions about NRT.
They included how long NRT should be used for, whether NRT should be used on a set schedule or as wanted, and whether more people stop smoking using NRT when it was provided free, versus if they had to pay for it.
‘‘However, more research is needed to answer these questions.’’ — NZME