Comparing Smoking Cessation Pharmacotherapies

SOURCE: Baker TB, et al. Effects of nicotine patch vs varenicline vs combination nicotine replacement therapy on smoking cessation at 26 weeks: A randomized clinical trial. JAMA 2016;315:371-379.

Pharmacotherapy for smoking cessation is only modestly effective. Clinicians often want to intensify smoking cessation pharmacotherapy in an effort to enhance cessation rates. Does it make a difference?

Baker et al randomized adult smokers (n = 1086) to one of three regimens: varenicline alone (VAR), nicotine replacement therapy patch (NRT-P) alone, or NRT-P plus nicotine replacement therapy lozenge (NRT-L) combined (NRT-P + NRT-L). Subjects were treated for 12 weeks.

Outcomes were measured at 26 weeks and again at 52 weeks. At both endpoint measurement times, there was no significant difference among the three treatment arms: Abstinence rates hovered closely around the 20% mark for each of the interventions at both points in time.

Since the two monotherapy arms were as effective as intensified nicotine treatment (NRT-P + NRT-L), the additional expense and complexity of the latter treatment does not appear to be justified.