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Effectiveness of varenicline versus nicotine replacement therapy for smoking cessation with minimal professional support: evidence from an English population study

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Abstract

Rationale

Limited evidence from randomised controlled trials suggests that varenicline might be more effective than nicotine replacement therapy (NRT) in achieving abstinence from smoking. The comparative effectiveness of varenicline when prescribed under routine circumstances and in the general population has not been tested.

Objectives

To compare the abstinence rates of smokers trying to stop having used varenicline vs. NRT on prescription (Rx) when provided with minimal professional support in the general population while adjusting for key potential confounders.

Methods

A large survey of a representative sample of the English population. Participants were 1,579 adults who smoked within the previous 12 months and made at least one quit attempt with varenicline or NRT Rx in their most recent quit attempt. The main outcome measure was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including urges to smoke. A sensitivity analysis was conducted in subsamples in which the quit attempt started up to 6 months or more than 6 months ago.

Results

The adjusted odds of abstinence in users of varenicline were 1.76 (95 % CI = 1.22–2.53) times higher compared with users of NRT Rx. However, there was no detectable difference in the subsample of smokers who started their quit attempt more than 6 months ago (adjusted OR = 1.03, 95 %CI = 0.54–1.96).

Conclusions

Varenicline use with minimal professional support in the general population of smokers appears more effective than NRT Rx in achieving short-term abstinence. However, this effect may disappear in the long-term. Research is needed to confirm this and establish what may underlie it.

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Acknowledgments

The Smoking Toolkit Study is funded by the English Department of Health, Cancer Research UK, Pfizer, GlaxoSmithKline and Johnson and Johnson. Pfizer, Johnson and Johnson and GlaxoSmithKline are manufacturers of smoking cessation products who had no involvement in the design of the study, collection, analysis or interpretation of the data, the writing of the report or the decision to submit the paper for publication.

Conflict of interest

RW has undertaken research and consultancy and received travel funds from companies that develop and manufacture smoking cessation medications. He has a share of a patent for a novel nicotine delivery device. He is a trustee of the stop smoking charity, QUIT and co-direct of the National Centre for Smoking Cessation and Training. DK has received an unrestricted research grant from Pfizer for a smoking cessation trial. JB has received an unrestricted research grant from Pfizer. This study is partly funded by Pfizer under an investigator initiated award.

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Authors and Affiliations

  1. Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 6BT, UK

    Daniel Kotz, Jamie Brown & Robert West

  2. Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200, MD, Maastricht, The Netherlands

    Daniel Kotz

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  1. Daniel Kotz
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  2. Jamie Brown
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Correspondence to Daniel Kotz.

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Kotz, D., Brown, J. & West, R. Effectiveness of varenicline versus nicotine replacement therapy for smoking cessation with minimal professional support: evidence from an English population study. Psychopharmacology 231, 37–42 (2014). https://doi.org/10.1007/s00213-013-3202-x

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  • DOI: https://doi.org/10.1007/s00213-013-3202-x

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