Combination therapies are the most effective smoking cessation drugs, says review

Combination therapies, particularly varenicline and combined nicotine replacement therapy (NRT), are the most effective smoking cessation drug therapies.

The study, led by the University of Bristol, and published today [12 October] in Addiction, was funded by the National Institute for Health Research (NIHR), the research partner of the NHS, public health and social services.

Varenicline, bupropion, and NRT are recommended as first-line treatments for smoking cessation by the National Institute for Health and Care Excellence (NICE). Electronic cigarettes can be used to help quit smoking, but there are currently no medically licensed electronic cigarettes in the UK. Since smoking is a leading cause of premature death and disease worldwide and is expensive, the objective of the research was to determine the clinical efficacy and safety of varenicline. , bupropion, TSN and electronic cigarettes compared to others.

Previous reviews of smoking cessation drugs have rarely looked at combinations of smoking cessation pharmacotherapies, looking at monotherapies or a combination of NRTs. Concerns have also been raised about the safety of e-cigarettes following a U.S. outbreak of severe lung damage among users of e-cigarettes containing tetrahydrocannabinol (THC), especially those obtained from informal sources, such as friends. and online resellers.

The researchers identified 363 efficacy trials and 355 safety trials. Most single and combination therapies were more effective than placebo in helping people quit smoking, with varenicline monotherapy and varenicline plus TNS combined being the most effective. Bupropion has also been shown to be effective, but has been associated with an increased risk of having a serious adverse event. Electronic cigarettes have shown promise, but more research is needed to establish their safety.

Although e-cigarettes have shown promise as a way to quit smoking, more research is needed on their long-term efficacy and safety, preferably in studies with active interventions as comparators.

We also recommend further research to explore the effectiveness of pharmacological treatment combined with psychological counseling or interventions. “

Dr Kyla Thomas, Senior Lecturer in Public Health Medicine, Bristol School of Medicine: Population Health Sciences (PHS), University of Bristol and lead author

Dr Michael Dalili, Senior Public Health Research Associate at Bristol Medical School: PHS and co-author, added: NICE recommendations. Our results should reassure patients, clinicians and policy makers about the safety of these treatments. “

The results could have implications for the approval of smoking cessation treatments, as e-cigarettes and combination therapies are currently not approved and could influence recommended treatments.

NICE will soon publish its new guide for “Tobacco: preventing absorption, promoting smoking cessation and treating addiction”, which will include the data from this study.

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