Researchers Identify Most Effective Stop-Smoking Aids
By UNIVERSITY OF MASSACHUSETTS
AMHERST
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Dual forms of nicotine replacement therapy
(NRT), such as combining a patch with gum or a lozenge, were found to be nearly
as effective.
Smoking remains the leading cause of
preventable disease and death worldwide, and many people who want to quit
smoking find it very difficult, due to the addictive nature of nicotine. The
new study’s findings offer strong evidence to help reshape public health
policies and strategies, offering smokers more effective tools to quit for
good.
Research Insights and Methodology
“The best thing someone who smokes can do for their health is to quit smoking,” says Jamie Hartmann-Boyce, assistant professor of health policy and management in the School of Public Health and Health Sciences.
“Our findings provide clear evidence of the effectiveness
of nicotine e-cigarettes and combination nicotine replacement therapies to help
people quit smoking. The evidence also is clear on the benefits of medicines
cytisine and varenicline, but these may be harder for some people to access at
the moment.”
Hartmann-Boyce is senior author of the paper
published recently in the Cochrane Database of Systematic
Reviews. She conducted the research at the University of Oxford, England, where she then worked as an
associate professor and director of the Evidence-based Healthcare Ph.D. Program
at Oxford’s Nuffield Department of Primary Care Health Sciences. The team also
included colleagues at the University of Leicester in the UK.
Comprehensive Analysis of Smoking Cessation Methods
Nicola Lindson, lead author and a senior
researcher at Oxford’s Nuffield Department of Primary Care Health Sciences,
notes that the team compared the results for different stop-smoking aids
that have been used in over 300 clinical trials involving more than 150,000
people.
“Our research dives deep into the world of
smoking cessation,” she says. “By pulling together this data, we can see that
when people use the medicines licensed for quitting smoking or nicotine
e-cigarettes, they are more likely to quit than if they do not use these aids.”
Efficacy of Different Cessation Aids
The analysis found that around 14 of 100
people trying to quit smoking are likely to succeed using a nicotine
e-cigarette, varenicline, or cytisine, in any given attempt to quit. For those
using two forms of NRT, about 12 of 100 will likely quit smoking, defined as no
smoking for at least six months. The success rate drops to around nine in 100
for those using only one form of NRT, such as a patch or gum.
Those rates compare to the finding that
around six in 100 people will be successful at quitting smoking without any
aids. Stop-smoking aids work better when people also receive behavioral support
to quit. Serious side effects were rare for all the stop-smoking options, the
study also found.
Considerations on Long-term Effects and Accessibility
Hartmann-Boyce points out that the long-term effects of using nicotine e-cigarettes are not known, but she emphasizes that the studies the team reviewed were testing regulated nicotine-containing e-cigarettes without additional additives known to cause harm.
This review
focused exclusively on evaluating the effects of a range of smoking cessation
methods and did not set out to investigate broader aspects of the public health
discourse regarding e-cigarettes, including their use among nonsmokers and young
people.
“Nicotine itself is not the thing that causes
the many diseases we associate with smoking,” Hartmann-Boyce says. “Broad
scientific consensus is that regulated nicotine e-cigarettes are highly, highly
likely to be much less harmful than conventional cigarettes, but not
harmless.”
Both varenicline, a World Health Organization essential medicine, and cytisine help reduce the symptoms of withdrawal. The brand-name form of varenicline – Champix – is not available in the U.S. and other parts of the world due to a manufacturing problem, though generic forms of varenicline have been approved by the FDA.
Cytisine is not
currently licensed or marketed in the U.S. and most other countries outside of
Central and Eastern Europe.
Reference: “Pharmacological and electronic
cigarette interventions for smoking cessation in adults: component network meta‐analyses”
by Nicola Lindson, Annika Theodoulou, José M Ordóñez-Mena, Thomas R Fanshawe,
Alex J Sutton, Jonathan Livingstone-Banks, Anisa Hajizadeh, Sufen Zhu, Paul
Aveyard, Suzanne C Freeman, Sanjay Agrawal and Jamie Hartmann-Boyce, 12
September 2023, Cochrane Database of Systematic Reviews.
DOI:
10.1002/14651858.CD015226.pub2