Nicotine replacement therapy versus control for smoking cessation

Introduction
Nicotine replacement therapy (NRT) is designed to reduce withdrawal symptoms by substituting nicotine from cigarettes with safer delivery forms.
This Cochrane systematic review evaluates the effectiveness and safety of NRT versus placebo or no treatment for long-term smoking cessation.
The review synthesizes evidence from randomized controlled trials with follow-up of ≥6 months.
Key Points
Evidence base: 136 randomized trials involving 64,640 participants, primarily adult smokers motivated to quit.
Effectiveness: Any form of NRT increases smoking cessation rates by 50–60% compared with control (pooled RR = 1.55).
Across products: All licensed NRT forms (gum, patch, lozenge/tablet, inhaler, nasal spray) are effective, with similar relative benefits.
Consistency: Effectiveness is largely independent of setting, intensity of behavioral support, or abstinence definition.
Safety: Adverse effects are generally mild and product-specific (e.g., skin irritation from patches, oral irritation from gum/lozenges).
Serious events: Serious adverse cardiovascular events are rare; small increases in palpitations or chest discomfort were observed but were uncommon.
Conclusion
There is high-quality, stable evidence that NRT significantly improves long-term smoking cessation outcomes.
NRT is effective across delivery forms and real-world settings, with an acceptable safety profile.
Further research is unlikely to change confidence in the overall effectiveness of NRT for smokers motivated to quit.

Hartmann‐Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews 2018, Issue 5. DOI: 10.1002/14651858.CD000146.pub5.