Combination nicotine replacement therapy, varenicline shows benefit for smoking cessation
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Using a combination of nicotine replacement therapy and varenicline may be more effective as first-line therapy for smoking cessation than varenicline alone, according to data presented at the CHEST Annual Meeting.
“Nicotine replacement therapy and varenicline are both effective in helping smokers quit,” Akesh Thomas, MD, internal medicine resident at East State Tennessee University, said during the presentation. “There is growing interest in combining these two treatment methods for better outcomes, but none of the available first-line pharmacological therapies to treat tobacco dependence have been labeled for use in combination with other therapies.”
There are currently seven first-line pharmacotherapies available and recommended in clinical practice guidelines for smoking cessation, Thomas said, and all have been tested for effectiveness in increasing smoking cessation when used as monotherapies compared with placebo.
Thomas and colleagues conducted a systematic review and meta-analysis to evaluate whether combined nicotine replacement therapy and varenicline (Pfizer) provides any significant benefit over varenicline alone for smoking cessation. Researchers systematically searched the PubMed database for all randomized controlled trials from 2006 to April 2021 that compared nicotine replacement therapy and varenicline vs. varenicline alone..
Three studies involving 904 patients were included.
Compared with varenicline alone, combined nicotine replacement therapy and varenicline was superior for smoking cessation at 3 months (RR = 1.195; 95% CI, 1.048-1.363) and 6 months (RR = 1.376; 95% CI, 1.14-1.66), according to Thomas.
In addition, the researchers reported no significant difference in reported adverse events, including nausea (RR = 0.875; 95% CI, 1.048-1.363), abnormal dreams (RR = 0.926; 95% CI, 0.60-1.43) and insomnia (RR = 1.185; 95% CI, 0.779-1.801).
“Our results suggest that combination nicotine replacement therapy and varenicline is superior to varenicline alone, regarding [smoking] abstinence at 3 months and 6 months, and there is no difference in the adverse effects, including nausea, abnormal dreams and insomnia, between the two groups,” Thomas said.