Comparative Effectiveness of Smoking Cessation Medications: A National Prospective Cohort From Taiwan

Abstract

Background and objectiveRelative effectiveness of smoking cessation medications—varenicline, bupropion and nicotine replacement therapy (NRT)—remains unclear among smokers in real-world settings. Evidence in females and smokers with light/moderate nicotine dependence is particularly insufficient. This study compared the effectiveness of varenicline, bupropion or NRT gum relative to NRT patch, in achieving abstinence among recent quitters.MethodsIn a national smoking cessation program in Taiwan (2012–2015), a cohort of 11,968 participants received varenicline (n = 5,052), bupropion (n = 823), NRT gum (n = 1944) or NRT patch (n = 4,149). The 7-day, 1-month or 6-month point-prevalence was calculated based on self-reported last smoking event via telephone interview after 6 months. Logistic regression modellings estimated odds ratios (OR) and 95% confidence intervals (CI) for achieving abstinence using different modalities (NRT patch as referent). Models included age, sex, education, marital status, geographic region, smoke-years, nicotine-dependence level, medical institution, number of clinic visits and medication use duration. Analyses were further stratified by sex and dependence severity.ResultsParticipants were predominantly male (83%) with a mean age of 43.7±12.6 years. Varenicline users were more likely than NRT patch users to achieve abstinence, based on 7-day point-prevalence (OR = 1.30, CI: 1.19–1.44), 1-month point-prevalence (OR = 1.36, CI: 1.24–1.50) or 6-month point-prevalence (OR = 1.30, CI: 1.14–1.47). Compared with NRT patch, varenicline was associated with greater odds of being abstinent in women (OR = 1.29, CI: 1.01–1.65), men (OR = 1.31, CI: 1.18–1.46), those with light/moderate dependence (OR = 1.42, CI: 1.24–1.63) or smokers with severe dependence (OR = 1.19, CI: 1.04–1.37), based on 7-day point-prevalence. Differences in effectiveness were not observed between users of bupropion, NRT gum and NRT patch.ConclusionsIn smoking cessation clinics in Taiwan, varenicline users reported higher abstinence rates than NRT patch users after 6 months. Women and smokers with light/moderate nicotine dependence may also benefit from varenicline in actual clinical practice.

Effects of morbidity on smoking cessation: a national smoking cessation program

“…It is well known that a high level of nicotine dependency is a factor that can impinge on the success of smoking cessation efforts [ 22 ], and this study confirmed these results in patients with chronic diseases. Previous Korean and Taiwanese studies have also verified these results [ 10 , 23 ]. Completion of the program was significantly associated with smoking cessation, consistent with the results of our previous study [ 10 ].…”

Effects Assessment of Auricular Acupuncture and Group Counseling for Smoking Cessation in Senior High School Students

“…Nicotine replacement therapy such as patch or gum bupropion as well as counseling are advised in smoking cessation even though the success rate are still unsatisfactory (Karpinski, Timpe, & Lubsch, 2010;Wu et al, 2007). In Taiwan, despite varenicline user reported higher abstinence rate than NRT patch users, the serious neuropsychiatric symptoms observed in adult patients may limit scope of application (Chang, Lo, Chang, Hsueh, & Tsai, 2016). The study showed AA in combination with group counseling is a safe intervention which can lower nicotine reliance and daily tobacco consumption for smoking cessation.…”

Cost‐effectiveness analysis of treatment with varenicline for nicotine dependence compared with smoking cessation without pharmacotherapy in the real world

“…[22][23][24] The proportion of smokers who wished to quit smoking in Japan was higher among females than males, 2 whereas studies in other countries reported no sex differences. 25,26 Other studies reported no significant sex differences in the maintenance of smoking cessation, [27][28][29] whereas others suggested female varenicline users were more likely to maintain cessation 1 year after quitting. 30 Of note, our results suggest unique sex differences within the Japanese population.…”