We’ve always got plenty to say about smoking here at the Lifestyle Elf and few things make our pointy ears prick up as fast as hearing about new, high quality evidence on what can help people quit. So we’re very pleased to see a Cochrane overview on the effectiveness and safety of medicines to help people quit smoking, published today on World No Tobacco Day. Overviews like this provide a summary of evidence from multiple systematic reviews looking at the same thing. So it’s a big, fat present for us evidence-hunters!
The overview includes twelve Cochrane reviews with over 101,000 adult smokers from 267 randomised controlled trials. The bulk of the evidence is about three medicines which are licensed in Europe and the USA to help people stop smoking and these are nicotine replacement therapy (NRT), bupropion and varenicline. They looked at long term quit rates, meaning not smoking for at least six months. Most included trials used biochemical tests of smoking status rather than relying on self-report – much more reliable!
Here’s what they found:
- More people quit with these medicines than with placebo (dummy medicine). For every 10 people who quit with placebo, around 18 can expect to quit using NRT or bupropion and 28 using varenicline
- Varenicline doubled the number of quitters compared with NRT (more when compared to nicotine gum) and more than doubled the chances of quitting compared with placebo
- NRT and bupropion were comparable and increased quit rates by about 80%
- Combinations of NRT were more effective than single NRT; nicotine gum was slightly less effective than other types of NRT
- There was a low risk of harmful effects, though the reviewers note that the results on safety may be less reliable than those on effectiveness and that questions remain about the possible harms of varenicline
In a press release, lead researcher Kate Cahill from Oxford University’s Department of Primary Care Health Sciences said:
This review provides strong evidence that the three main treatments, nicotine replacement therapy, bupropion and varenicline, can all help people stop smoking.
She also referred to data on cytosine, a medicine not currently licensed for smoking cessation in most of the world, as having “potential as an effective and affordable therapy”.
Last year I blogged about two Cochrane reviews which explored behavioural support in addition to medicines in helping people quit smoking. They found that combining medicines with behavioural support increased successful quitting and that the benefit increased with more intensive support. So there’s effective help out there for people wanting to quit.
This year, World No Tobacco Day takes as its theme a call for a ban on tobacco advertising, promotion and sponsorship. Hats off to Ireland for announcing this week that it is to follow Australia’s lead in introducing plain packaging for cigarettes, something the British government appears to have put on the back burner. While the debate rages, we’ll keep on digging out best evidence on smoking so check back soon.
Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009329.DOI:10.1002/14651858.CD009329.pub2.