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Using NRT Products In Combination Increases Chances Of Quitting Smoking, Cochrane Review Finds

Executive Summary

A new Cochrane systematic review shows that using a combination of nicotine replacement therapy (NRT) products is more effective than using only one type, and also that higher strength NRT products are more effective than their lower strength equivalents.

Smokers using combinations of nicotine-replacement therapy (NRT) products such as patches, gum or lozenges are up to a third more likely to successfully quit, according to a recently published Cochrane systematic review.

Analysing 63 trials with a total of 41,509 participants, the review found that using a nicotine patch together with another type of NRT – for example a gum or lozenge – made it 15% to 36% more likely that a person would successfully stop smoking than if they used one type of NRT alone.

The study also looked at the effectiveness of NRT products used in isolation at different strengths.

People were also more likely to quit successfully if they used higher‐dose NRT products, reported the researchers based at the Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.

When it came to patches, the researchers learned that, over a 16-hour period, 25mg nicotine concentrations were more effective than 15mg, and over a 24-hour period, 21mg strengths were more effective than their 14mg equivalents.

Higher dose nicotine gum was also recommended by the research, with 4mg nicotine concentrations proving more effective than 2mg versions.

The timing of NRT was also crucial in quitting success, the researchers discovered. The review suggested that using NRT products the day before quitting and continuing their use thereafter helped more people to quit than only using it after quitting.

However, more evidence was needed to strengthen this conclusion, the study warned.

Finally, the review noted that people who smoke had the same chances of quitting successfully whether they used a nicotine patch or another type of NRT, such as gum, lozenges or nasal sprays.

NRT Or E-Cigarettes For Smoking Cessation?

While their effectiveness in helping people stop smoking has been proven consistently by clinical research, NRT has been significantly challenged by the emergence of e-cigarette use as both an alternative form of NRT and as a recreational habit replacing combustible tobacco smoking.

A study published at the beginning of the year by UK- and US-based researchers found that e-cigarettes were almost twice as effective at helping smokers give up tobacco than traditional forms of NRT.  (Also see "Health Market News: DXM Sales Age-Restriction Bill Filed, E-Cigarettes Top NRTs In UK Trial " - HBW Insight, 30 Jan, 2019.)

The randomised clinical trial – which involved 886 smokers who sought help through the UK National Health Service’s (NHS’s) smoking cessation services – concluded that, after one year, 18% of e-cigarette users had stopped smoking tobacco, compared to 9.9% of NRT users.

While this clearly challenged NRT as the most effective method of smoking cessation, the research also found that 80% of the e-cigarette users who had stopped smoking after one year were still vaping regularly.

Furthermore, questions about the long-term safety of e-cigarettes remained unanswered, the NHS pointed out.

While the study found no evidence of harm from e-cigarettes during the one-year period, the NHS noted that it was also unclear “whether the chemicals in e-cigarettes, particularly the flavourings, may have long-term harms that have not yet come to light.”

Nevertheless, e-cigarettes were “likely to be much less harmful than long-term tobacco smoking,” the NHS concluded, adding that a previous review had estimated that e-cigarettes were about “95% less harmful than smoking tobacco.”



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