Cigarette smoking is associated with cancer, respiratory disease, and cardiovascular disease. It is reported that 19% of Canadians aged 15 years and older were smokers in 2007. Each year, approximately 45,000 Canadians die from smoking. Cigarette smoking is considered the leading preventable cause of mortality. Smoking cessation reduces the risk of developing and dying from smoking-related diseases. Although approximately 70 percent of smokers plan to quit and over 40 percent of smokers report that they tried to quit, the long-term success rate of any unaided quit attempt is low, with only 3 to 7 percent of smokers who make an attempt still abstinent one year later. With optimal treatment, one-year cessation rates after a single quit attempt can exceed 30 percent.
For most of smokers, smoking is both a learned behavior and a physical addiction to nicotine. The combination of counseling and pharmacologic therapies can produce higher quit rates than either one alone. Pharmacotherapy therapy for smoking cessation, including nicotine replacement therapy (NRT), bupropion, and varenicline, aims to reduce the symptoms of nicotine withdrawal, thereby making it easier for a smoker to stop the habitual use of cigarettes.
In NRT, non-toxic forms of nicotine delivery systems are used to provide nicotine to maintain stimulation of nicotine receptors, thereby eliminating withdrawal symptoms and the sensations of craving for nicotine during a smoking cessation attempt. It has been reported that nicotine products can help people to reduce smoking before quitting smoking. In 2010, CADTH published a health technology assessment (HTA) report on pharmacologic-based strategies for smoking cessation, in which the clinical and cost-effectiveness of NRT products including the nicotine patch, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray and nicotine sublingual tablets were systematically evaluated. The author concluded that all pharmacotherapies including NRT are efficacious in helping the general population quit smoking. Since the publication of that report, newer NRT products such as Nicorette Quick Mist, Nicorette Combo Quit, and Nicorette Mini Lozenges have entered the Canadian market. Nicorette QuickMist is a mouth spray and is available in a 1 mg nicotine/spray dose strength. Nicorette ComboQuit is a combination of nicotine patches plus nicotine gum. Nicorette Mini Lozenges come in two strengths (2 mg and 4 mg). The 2 mg strength is recommended for smokers who have a first cigarette more than 30 minutes after waking up; the 4 mg lozenge is recommended for those having a first cigarette within 30 minutes of waking up. A smoker’s dependence on nicotine can be assessed from the duration of smoking history, the number of cigarettes smoked daily, and how soon the smoker needs to smoke after waking in the morning. The smoker's degree of nicotine dependence predicts the difficulty that the smoker will have in quitting and the intensity of treatment likely to be required. The dosing of most NRT products varies based on the number of cigarettes smoked daily. Nicotine transdermal patches are supplied in different dosages ranging from 5 mg to 15 mg over 16 hours. While there is no standard definition of high dose nicotine product was identified, the high dose of nicotine patch was defined as the dose greater than 22 mg per day.
The objective of this review is to evaluate the clinical effectiveness of the newer NRT products including Nicorette QuickMist (or nicotine mouth spray), Nicorette ComboQuit (or combination of patches plus gum) or Nicorette Mini Lozenges (2 mg or 4 mg), use of supratherapeutic doses (high dose) of NRT, and use of NRTs to reduce smoking for those who do not plan to quit.
Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources and a summary of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.
