What are the most effective treatments for tobacco cessation?

From the Guidelines

The most effective approach to tobacco cessation is a combination of pharmacologic therapy and behavior therapy, with the two most effective pharmacotherapy agents being combination nicotine replacement therapy (NRT) and varenicline, as supported by the most recent evidence from 2021 1.

Key Components of Tobacco Cessation

• Medication Therapy: First-line medications include nicotine replacement therapy (NRT) in various forms (patches, gum, lozenges, inhalers, or nasal spray), varenicline (Chantix), and bupropion (Zyban) 1.
• Behavioral Support: High-intensity behavior therapy with multiple counseling sessions is most effective, but at least a minimum of brief counseling is highly recommended 1.
• Combination Therapy: Combining different forms of NRT (like using patches for baseline cravings plus gum or lozenges for breakthrough cravings) increases success rates, and using a combination of NRT products has been found to be more effective than using a single form of NRT 1.

Implementation of Tobacco Cessation

• Setting a Quit Date: Setting a specific quit date is crucial for planning and preparation.
• Identifying Triggers: Identifying personal triggers for smoking is essential for developing coping strategies.
• Coping Strategies: Developing strategies for managing cravings and avoiding triggers is vital for long-term success.
• Social Support: Seeking social support from family, friends, or support groups can significantly enhance the chances of successful cessation.

Persistence and Relapse

• Multiple Quit Attempts: Most people require multiple quit attempts before achieving long-term success.
• Relapse Prevention: Persistence is key, even if relapse occurs, and individuals should be encouraged to continue attempting to quit.
• Continuous Support: Continuous support and guidance from healthcare providers can help individuals stay on track with their quit plan.

From the FDA Drug Label

The patient should set a date to stop smoking. Begin varenicline tablets dosing one week before this date Alternatively, the patient can begin varenicline tablets dosing and then quit smoking between days 8 and 35 of treatment. Patients should be treated with varenicline tablets for 12 weeks. For patients who have successfully stopped smoking at the end of12 weeks, an additional course of 12 weeks treatment with varenicline tablets is recommended to further increase the likelihood of long-term abstinence

The most effective treatment for tobacco cessation with varenicline tablets is a 12-week course of treatment, with an optional additional 12-week course for patients who have successfully stopped smoking, to further increase the likelihood of long-term abstinence 2.

• Varenicline tablets should be taken orally after eating and with a full glass of water, with a recommended dose of 1 mg twice daily following a 1-week titration.
• Patients who are motivated to quit and have not succeeded in stopping smoking during prior varenicline tablets therapy should be encouraged to make another attempt with varenicline tablets once factors contributing to the failed attempt have been identified and addressed.

From the Research

Effective Treatments for Tobacco Cessation

The most effective treatments for tobacco cessation include a combination of pharmacotherapy and behavioral support. Some key points to consider are:

• Combining medication and behavioral counseling is associated with a higher quit rate compared to brief advice or usual care 3
• Varenicline, bupropion, and nicotine replacement therapy (NRT) are effective treatments for smoking cessation, with varenicline showing a significantly higher 6-month quit rate than bupropion and NRT 3
• Combining a nicotine patch with other NRT products is more effective than using a single NRT product 3
• Combining drugs with different mechanisms of action, such as varenicline and NRT, can increase quit rates compared to using a single product 3

Comparison of Treatments

Studies have compared the effectiveness of different treatments for smoking cessation, including:

• A meta-analysis of 19,488 people who smoked cigarettes found that the combination of medication and behavioral counseling was associated with a quit rate of 15.2% over 6 months, compared to 8.6% with brief advice or usual care 3
• A randomized double-blind clinical trial of 8,144 people who smoked found that varenicline had a significantly higher 6-month quit rate than bupropion and NRT 3
• A review of 53 studies with over 25,000 participants found that combining pharmacotherapy and behavioral support increased smoking cessation success compared to a minimal intervention or usual care 4

Pharmacological Treatments

Pharmacological treatments for smoking cessation include:

• Nicotine replacement therapy (NRT), which can increase 6-month abstinence rates by more than 80% compared to placebo 5
• Bupropion, which can increase 6-month abstinence rates by more than 80% compared to placebo 5
• Varenicline, which can double success rates compared to placebo and is 50% more effective than nicotine patch and 70% more effective than nicotine gum 5

Behavioral Support

Behavioral support for smoking cessation can be effective, including:

• Motivational interviewing and cognitive behavior therapies, which have been proven to be effective but are not widely available 5
• Smoking cessation mobile applications and smartphone applications, which may be promising in terms of effectiveness and could be useful for reaching more smokers 5
• Shared decision-making, which involves patients in the choice of medication and incorporates their preferences in the decision process, and can promote therapeutic adherence and increase the chances of successful quitting 6