Effects of different combined behavioral and pharmacological interventions on smoking cessation: a network meta-analysis of 103 randomized controlled trials

Background Both behavioral therapies and pharmacotherapy are effective in smoking treatment. Combining both treatment approaches is recommended in clinical practice. Objective We conducted a network meta-analysis to assess the comparative impact of various combined behavioral and pharmacological interventions on smoking cessation. Methods We searched four electronic databases to identify randomized controlled trials evaluating combined interventions on smoking cessation. The risk of bias of the included studies was evaluated according to the Cochrane tool. Network meta-analysis was performed to calculate the relative risk (RR) and 95% confidence interval (CI) through R-3.4.0. The certainty of evidence was assessed using the grading of recommendation, assessment, development, and evaluation approach. Results A total of 103 studies with 38118 participants were included. The results demonstrated that Varenicline + Cognitive behavioral therapy (CBT) is significantly more effective for smoking cessation than Bupropion + Counselling (RR = 0.39, 95%CI [0.22, 0.70]), Nicotine replacement therapy (NRT) + Counselling (RR = 0.37, 95% CI [0.22, 0.62]), NRT + Tailoring (RR = 0.49, 95% CI [0.29, 0.83]), and Varenicline + Counselling. Bupropion + CBT is more likely to achieve success relative to Bupropion + Counselling and NRT + Counselling. NRT + CBT is more likely to achieve success relative to Bupropion + Counselling, NRT + Counselling, and NRT + Tailoring. Conclusions Among combined interventions for smoking cessation, Varenicline + CBT, NRT + CBT + Financial incentive, and Bupropion + CBT demonstrate the highest levels of success. CBT, FI, and Varenicline are potential intervention components that may possess greater effectiveness.