New review highlights top strategies for smoking cessation

A major new scientific review of evidence published in the journal Addiction has identified three top strategies for quitting smoking:

• Varenicline -- a prescription drug sold under the brand names Chantix and Champix among others.
• Cytisine -- a plant-based compound available under prescription in the United Kingdom, in Canada as an over-the-counter natural health product (Cravv®) and throughout central and eastern Europe.
• Nicotine e-cigarettes.

These work best when combined with behavioural support, such as counselling. Bupropion and nicotine replacement therapy (NRT) are also effective, especially NRT patches combined with fast acting forms like gum. There is strong evidence to support behavioural counselling and financial incentives for smoking cessation, even without additional medication.

The Cochrane Tobacco Addiction Group (CTAG) has provided systematic reviews of the highest quality for almost 30 years. This summary outlines the key findings from the fourteen Cochrane reviews that CTAG published between 2021 and 2023. Three Cochrane reviews included in this summary are particularly noteworthy:

• The updated Cochrane review on nicotine replacement therapy (NRT) for smoking cessation found high-certainty evidence that combining a fast-acting form of NRT (gum, lozenges, sprays) with NRT patches helped more people to quit than single-form NRT alone.
• The Cochrane review of electronic cigarettes for smoking cessation is a living systematic review: review authors search for new studies monthly and update the review whenever new data emerge. The latest update concluded that there was high‐certainty evidence that e-cigarettes with nicotine increase quit rates compared with NRT and moderate‐certainty evidence that they increase quit rates compared with e-cigarettes without nicotine.
• The 2023 Cochrane review of pharmacological and e-cigarette interventions for smoking cessation included all drugs licensed as treatments for smoking cessation anywhere in the world, as well as e-cigarettes with or without nicotine. The review included 319 studies (157,179 participants). The most effective interventions were nicotine e‐cigarettes, varenicline and cytisine, all of which had high certainty evidence, closely followed by combination NRT (i.e. the use of a patch and fast-acting form of NRT together).
• The updated Cochrane review on nicotine receptor partial agonists (varenicline and cytisine) for smoking cessation found that, in studies directly comparing cytisine and varenicline, there may be no difference from either medication for quitting smoking. The review included 75 trials.

Quitting smoking is difficult, and some people find it harder to quit than others, but tobacco is uniquely deadly among legal consumer products, so it's important to seek help quitting. There's a range of effective forms of support for smoking cessation, and cytisine, varenicline and e-cigarettes are all evidence-based ways to greatly increase people's chances of successfully quitting smoking."

Dr. Jonathan Livingstone-Banks, Lead Author