No Significant Benefit Found with Smoking Cessation Medications Alone
Pharmaceuticals alone might not be as effective as hoped in helping smokers quit the habit, but a new study suggests that combining that with behavioral counseling might do the trick. Find out what researchers found about the effectiveness of smoking cessation drugs in the real world compared to original trials.
SAN DIEGO – Smoking cessation drugs might not be as effective as original research indicated, according to a new study.
An article posted online by the Journal of the National Cancer Institute suggests that real world results don't appear as promising as clinical trials results. In fact, University of California San Diego School of Medicine-led researchers posit that, in general, smoking cessation drugs might not improve the chances of successful quitting used alone.
"Thirty four percent of people who are trying to quit smoking use pharmaceutical aids and, yet most are not successful," said senior author John P. Pierce, PhD, Professor Emeritus in the Department of Family Medicine and Public Health at UC San Diego School of Medicine and Moores Cancer Center. "The results of randomized trials that tested these interventional drugs showed the promise of doubling cessation rates, but that has not translated into the real world."
The study sought to assess the effectiveness of three first-line medications recommended by clinical practice guidelines: varenicline, bupropion and nicotine replacement therapy (patch). To do that, researchers collected data from the Current Population Survey-Tobacco Use Supplement -- a U.S. Census survey of adults 18 years or older which was conducted to obtain information about the country's use of tobacco products.
With two cohorts surveyed about one decade apart, researchers employed a method known as "matching" to help balance comparison groups on factors that could lead individuals to be more likely to use a cessation aid but also make it more difficult for them to quit, such as how many cigarettes w used in a designated time period.
The effectiveness of medications to aid quitting among baseline adult smokers who attempted to quit prior to one year of follow-up in two longitudinal studies – 2002–2003 and 2010–2011 – was assessed. Using propensity score models with 12 potential confounders (age, sex, race-ethnicity, education, smoking intensity, nicotine dependence, previous quit history, self-efficacy to quit, smoke-free homes, survey year, and cessation aid use), 2,129 pharmaceutical aid users and nonusers with complete data were matched. The researchers sought to determine if any individual pharmaceutical aid increased the proportion of patients who were abstinent for 30 days or more at follow-up.
No evidence was found that use of varenicline (adjusted risk difference [aRD] = 0.01, 95% confidence interval [CI] = –0.07 to 0.11), bupropion (aRD = 0.02, 95% CI = –0.04 to 0.09), or nicotine replacement (aRD = 0.01, 95% CI = –0.03 to 0.06) increased the probability of 30 days or more smoking abstinence at one-year follow-up.
"In these analyses, matching helped reduce bias," explained first author Eric Leas, PhD. "Still, we found no evidence that the pharmaceutical cessation aids that we assessed improved the chances of successfully quitting. This was both surprising, given the promise of smoking cessation seen in randomized trials, and disappointing because of the need for interventions to help smokers quit."
The use of intensive behavioral counseling in combination with pharmaceutical aids was cited as a factor, however, that might have contributed to an increase in smoking cessation rates during clinical trials. "Smokers who are committed to quitting and want to use a pharmaceutical aid should also enroll in a program that could help them track their progress and support them in their attempt," Leas said.
"The lack of effectiveness of pharmaceutical aids in increasing long-term cessation in population samples is not an artifact caused by confounded analyses," study authors concluded. "A possible explanation is that counseling and support interventions provided in efficacy trials are rarely delivered in the general population."