Abstract
Non-invasive brain stimulation (NIBS) is emerging as a promising treatment for nicotine dependence. Several systematic reviews discuss the effectiveness of repetitive transcranial magnetic stimulation (rTMS) as monotherapy for smoking cessation; however, its effectiveness in combination with conventional pharmacotherapy has not been well studied. We performed a systematic review of randomized controlled trials (RCTs) that investigated the efficacy of a combination of NIBS and conventional pharmacotherapy for smoking cessation. The primary outcomes were smoking abstinence rates. Secondary outcomes were craving, withdrawal symptoms and adverse events. We included 2 RCTs with a total of 79 smokers. At week 12, abstinence rates were 82.4% vs. 30.7% in Ibrahim et al., who combined rTMS/sham stimulation respectively with varenicline, and 27.7% vs. 27.7% in Trojak et al., who combined rTMS/sham stimulation with nicotine replacement treatment (NRT). The latter group reported that continuous abstinence was significantly higher in the active group (p = 0.027) only at week 2. Active rTMS led to a significant reduction in the FTCQ-12 compulsive craving dimension (p = 0.011). Neither study reported serious adverse events related to the interventions. Adjunctive rTMS improves short-term smoking abstinence and reduces craving when combined with pharmacotherapy compared with pharmacotherapy alone, with good tolerability.