Combined pharmacotherapy and behavioural interventions for smoking cessation

Abstract

Our earlier Cochrane Reviews already show that all types of nicotine replacement therapy help people to stop smoking,[1] as do several non-nicotine pharmacotherapies, including bupropion and varenicline, sold as Champix and Chantix.[2] We also know that providing behavioural support, such as individual[3] or group counselling,[4] helps people quit too, and trials of pharmacotherapy typically also provide behavioural support to all participants. Whilst encouraging the use of both is considered to be better, we haven't really been sure how much better and, so, this new review looks at the effects of the combination of an effective smoking cessation pharmacotherapy and behavioural support on helping people to stop smoking.[5] We aimed to identify all the randomised trials that provided people in the intervention group with a pharmacotherapy and behavioural support, and gave neither to people in the control group. Instead, the control group typically got some advice about quitting, which we know is likely to be of some help. We found 41 trials. When we pooled all their results, the findings from one study stood out as being much better, and so we limited the rest of the analyses to the 40 other studies. Overall, we found that the combined approach increased the chance of quitting by between 70 and 100%. And, even though the trials were done in many different settings, some with volunteers, and some in healthcare settings with patients who were not necessarily motivated to quit, we found that the size of effect was quite stable. There was slight evidence, when we compared different trials, that offering more sessions of support gave better results, but the difference was not clear. This may be because people don't make use of all the available support. We found the effect of more support was a little clearer when we just looked at trials which delivered more of the planned treatment. These results are important because they show that the effects of combined treatment with pharmacotherapy and behavioural support are quite robust, even in people who might be finding it hard to quit smoking.