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Meta-Analysis
. 2015 Jul 22:15:689.
doi: 10.1186/s12889-015-2055-0.

Combination therapy of varenicline with nicotine replacement therapy is better than varenicline alone: a systematic review and meta-analysis of randomized controlled trials

Ping-Hsun Chang  1   2 , Chien-Hsieh Chiang  3   4   5 , Wei-Che Ho  6 , Pei-Zu Wu  7 , Jaw-Shiun Tsai  8   9 , Fei-Ran Guo  10   11
Affiliations
Meta-Analysis

Combination therapy of varenicline with nicotine replacement therapy is better than varenicline alone: a systematic review and meta-analysis of randomized controlled trials

Ping-Hsun Chang et al. BMC Public Health. .

Abstract

Background: Smoking is a major preventable cause of morbidity and premature death worldwide. Both varenicline and nicotine replacement therapy (NRT) help achieve smoking cessation. However, limited evidence exists regarding whether combination of varenicline and NRT is more effective than either alone. The aim of this research was to investigate the efficacy and safety of varenicline combined with NRT.

Methods: A systematic search of MEDLINE, EMBASE, ClinicalTrial.gov, and Cochrane Library was conducted in November 2014. Two authors independently reviewed and selected randomized controlled trials. The quality of the studies was evaluated by the Jadad score. We carried out meta-analysis of both early (abstinence rate assessed before or at the end of treatment) and late (assessed after the end of the treatment) outcomes.

Results: Three randomized controlled trials with 904 participants were included in this meta-analysis. All three were comparing combination therapy with varenicline therapy alone. The late outcomes were assessed in 2 of the 3 trials. Both the early and late outcomes were favorable for combination therapy (OR = 1.50, 95 % CI 1.14 to 1.97; OR = 1.62, 95 % CI 1.18 to 2.23, respectively). However, this significance diminished after eliminating a study with pre-cessation treatment using nicotine patch. The most common adverse events were nausea, insomnia, abnormal dreams, and headache. One study reported more skin reactions (14.4 % vs 7.8 %; p = 0.03) associated with combination therapy.

Conclusions: Combination therapy is more effective than varenicline alone, especially if pre-cessation treatment of nicotine patch is administrated. Adverse events of combination therapy are similar to mono-therapy except for skin reactions.

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Figures

Fig. 1
Fig. 1
Flow diagram of meta-analysis: inclusion and exclusion of studies
Fig. 2
Fig. 2
Varenicline plus nicotine patch vs varenicline plus placebo patch: the early outcome
Fig. 3
Fig. 3
Varenicline plus nicotine patch vs varenicline plus placebo patch: the late outcome
See this image and copyright information in PMC

References

    1. Jha P. Avoidable global cancer deaths and total deaths from smoking. Nat Rev Cancer. 2009;9:655–64. doi: 10.1038/nrc2703. - DOI - PubMed
    1. National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health: The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Atlanta GA: Centers for Disease Control and Prevention (US); 2014. - PubMed
    1. Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database Syst Rev. 2012;4 - PubMed
    1. Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report. Am J Prev Med. 2008;35:158–76. doi: 10.1016/j.amepre.2008.04.009. - DOI - PMC - PubMed
    1. Mills EJ, Wu P, Lockhart I, Thorlund K, Puhan M, Ebbert JO. Comparisons of high-dose and combination nicotine replacement therapy, varenicline, and bupropion for smoking cessation: a systematic review and multiple treatment meta-analysis. Ann Med. 2012;44:588–97. doi: 10.3109/07853890.2012.705016. - DOI - PubMed

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