Pharmacotherapies Significantly Improve the Chances of Abstinence From Cigarettes

A recent meta-analysis* revealed that smokers who use a pharmacotherapy to aid in smoking cessation were twice as likely, on average, to maintain complete abstinence from cigarettes. Researchers analyzed 70 randomized controlled trials comprising 32,908 participants. Seven approved pharmacotherapies at 6 and 12 months of use were evaluated, including gum, inhaler, nasal spray, patch, and tablet nicotine therapies, as well as an important comparison of the anti-depressant Bupropion (trade name Wellbutrin™) and nicotine receptor agonist Varenicline (trade name Chantix™) – both common prescription only smoking cessation aids.  This study is freely available as an open access article (link available at the end of this story).

The study presented data as “odds ratios” (OR) with credible intervals (think confidence intervals). For example, an OR of 2.0 indicates that someone is twice as likely to maintain abstinence than someone who took a placebo pill. The results of the meta-analysis revealed that all pharmacotherapies were significantly more effective than placebo. The specific results in no particular order were (odds ratio/credible interval):

1. Bupropion – 2.12 (1.76-2.56)
2. Nicotine Gum – 1.65 (1.37-2.01)
3. Nicotine Inhaler – 2.18 (1.38-3.45)
4. Nicotine Nasal Spry – 2.37 (1.57-3.60)
5. Nicotine Patch – 1.88 (1.60-2.22)
6. Nicotine Tablet – 2.06 (1.47-2.87)
7. Varenicline – 2.55 (1.99-3.24)

Importantly, Varenicline was found to be statistically superior to Bupropion in a head-to-head comparison. Physicians are urged to take note of this finding.

Abstinence is certainly a more stringent outcome measure for smoking cessation. Hence, the estimates above may be conservative since many smokers will “fall of the wagon” early on in treatment only to return to abstinence thereafter. In the current study, these smokers would be considered a treatment failure even if they went on give up smoking altogether.

Despite the statistically meaningful improvements in maintaining abstinence, the actual number of participants who successfully quit smoking as defined in this study were very low.  In fact, only 13%-26% of participants across all studies managed to stop smoking even with the aid of a pharmacotherapy. These numbers highlight just how difficult it is to quit smoking.  As someone trained in the behavioral sciences, I believe that this study highlights the need for concurrent behavioral interventions provided by a physician or psychologist.  I urge anyone who currently smokes to take the health risks seriously and to stop smoking today with guidance from a healthcare professional!

Download a full text PDF of this study here.

CFisher

Reference:
*Eisenberg, M., Filion, K., Yavin, D., Belisle, P., Mottillo, S., Joseph, L., Gervais, A., O’Loughlin, J., Paradis, G., Rinfret, S. & Pilote, L. (2008). Pharmacotherapies for smoking cessation: A meta-analysis of randomized controlled trials. randomized controlled trials. CMAJ, 179(2), 135-144.