Smoking is a major public health concern worldwide, leading to preventable diseases and deaths. However, quitting smoking at any age and regardless of smoking history can have significant health benefits. A recent review highlighted three top-performing smoking cessation strategies: varenicline, cytisine, and nicotine e-cigarettes. These strategies have shown increased success rates when used in combination with behavioral therapies.
Behavioral therapies and financial incentives have also shown potential for successful smoking cessation without the need for additional medications. The review from CTAG outlined key findings from papers published between 2021 and 2023, providing updated conclusions and key abstinence results from various treatments. The evidence quality was rated using the GRADE parameters, ranging from “high certainty” to “very low certainty”.
Varenicline, cytisine, and nicotine e-cigarettes were identified as the most effective treatments for smoking cessation. Varenicline, a prescription oral tablet, is more effective than bupropion or single-form nicotine replacement therapy (NRT). Cytisine, a plant-based prescription or over-the-counter oral tablet, has shown promising results in studies conducted in Canada and Europe. Both varenicline and cytisine work by binding to receptors that respond to nicotine, helping with withdrawal symptoms and blocking nicotine reinforcement.
The review also found that bupropion, an antidepressant, was more effective than placebo or no medications for smoking cessation, although users experienced more serious adverse events. Fast-acting NRT gums, lozenges, and sprays combined with transdermal patches were also more effective than single-form NRT alone. Behavioral therapy has been shown to increase quit rates at 6 months or longer, with or without smoking cessation medications, suggesting that a combination of therapies may increase the chances of successful quitting.
While mindfulness-based therapy did not show clear evidence of benefit or harm, the Cochrane Review of e-cigarettes found high-certainty evidence that e-cigarettes with nicotine may lead to higher quit rates than NRT. Switching from exclusive smoking to exclusive vaping or dual use of combustible and e-cigarettes may reduce levels of harm-related biomarkers. However, more research is needed to fully understand the process of quitting vaping and effective support methods.
The review also highlighted associations between smoking cessation and reduced risk of major cardiovascular events, improved symptoms of anxiety and depression, and the restoration of endothelial and platelet function. Quitting smoking has been linked to improved mental health outcomes, particularly in subpopulations with mental illnesses. Further research is needed to understand the link between smoking and mental health conditions and to explore individual tailoring for behavioral support and smoking cessation methods.
