Research: Large study compared different tools to quit smoking

E-cigarettes are as effective in smoking cessation as the drugs varenicline and cytisine. This is according to a comprehensive review published in the Cochrane Journal.
"We found evidence with high confidence that these are the three most effective smoking cessation tools we have today." the researchers write in their analysis.

How do medications such as Champix (varenicline) and similar preparations compare with e-cigarettes and other nicotine medicines in various quit attempts? Researchers at Oxford and Leshister Universities wanted to find out.

In total, over 150 000 people were included in the 300 studies analysed. The studies were 'randomised controlled trials' and followed those trying to quit smoking for at least six, but up to 12, months.

"E-cigarettes were found to help about 14 out of 100 who quit smoking. This compares to 6 out of 100 who did not use any of the studied aids," the researchers write in the University of Oxford News.

Medicines effective - but not available

The drugs varenicline (champix in Sweden) and cytisine were equally effective. However, the researchers note that varenicline, a drug on the WHO list of essential medicines, is currently (2023) not available in Europe, South America, Japan or parts of North America due to a manufacturing problem.

"Cytisine is also not currently licensed or marketed in countries outside of central and eastern Europe, meaning that it is de facto not available in much of the world, even in the UK and the US," the researchers write.

Weaker evidence for comination therapy

The researchers also found evidence that combinations of various other medicines were effective in smoking cessation. This is especially true for different treatments with nicotine patches. But here the evidence was somewhat inconclusive.

'We base this conclusion on studies that evaluated one drug at a time and not simultaneously in a single intervention. However, there is strong evidence that, for example, nicotine spray and tablets in combination with strong nicotine patches provide benefits compared to using only one of these tools at a time," the researchers write.

Studying e-cigarettes since 2014

The study was published Cochrane Database of Systematic Reviews and adds to the range of smoking cessation studies that Cochrane regularly publishes on the subject. The aim is to provide evidence for healthcare providers making decisions about treatment options. Since 2014, e-cigarettes have been included in comparisons with medicines and nicotine products designed to help smokers quit. By 2022, the Cochrane concluded that e-cigarettes with nicotine are twice as effective for smoking cessation like traditional nicotine medicines.

The current analysis included varenicline and cytisine and classical NRTs as well as bupropion, in addition to pathway products.

Cochrane reviews also analyse the potential side effects of different preparations and have not noted any serious, lasting side effects in the short and medium term of either e-cigarettes or other nicotine replacement products, when they are is used in smoking cessation programmes.

No evidence in Sweden

According to the Swedish Public Health Agency and the National Board of Health and Welfare, there is currently no evidence on the effectiveness of e-cigarettes in smoking cessation. Although Cochrane's data-based analyses are often used in evaluations even in Sweden, e-cigarettes are not recommended for smoking cessation. smoking cessation in Sweden. At the same time, neither Varenicline nor Cytisine is available in Sweden, something that has been highlighted in various media.

Read more:
Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta-analyses

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