[Combinations of pharmacological treatments in smoking cessation. A systematic review]

Abstract

Introduction: The effectiveness of the three validated smoking cessation medications, nicotine replacement therapy, varenicline and bupropion, may be insufficient, in hard-core smokers.

Objectives: This systematic review investigates the efficacy of combinations of different medications in smoking abstinence and their tolerability.

Results: Three randomized controlled trials (RCTs) compared the combined medications with varenicline and nicotine patches vs. varenicline; two found an increase in abstinence rates with the combined medications. In one study, the beneficial effect was only observed in heavy smokers. The four RCTs comparing the combined medications with varenicline and bupropion (vs. varenicline) demonstrated an increase in abstinence rates with the combined medications, most often in heavy smokers who are very dependent on tobacco. The results of the three RCTs comparing the combined medications with bupropion and nicotine replacement therapy vs. varenicline were discordant. Three studies included other molecules (mecamylamine, selegiline, sertraline, buspirone). Combined medications were well tolerated.

Conclusion: Combination treatments can achieve higher smoking abstinence rates than monotherapies, especially in smokers who have failed to quit (Hard-core smokers). Treatment with a combination of varenicline and nicotine replacement therapy is a therapeutic option in smoking cessation.

Keywords: Bupropion; Combinaison; Combination; Nicotine replacement therapy; Pharmacological treatments; Sevrage tabagique; Smoking cessation; Substituts nicotiniques; Traitements pharmacologiques; Varenicline; Varénicline.