Smokers are more likely to quit using e-cigarettes or smoking cessation medicines, according to a new analysis led by the University of Oxford.
In a review of over 300 clinical trials, researchers found that the most effective way to help people stop smoking is through the use of e-cigarettes and medicines such as varenicline and cystisine. This is closely followed by nicotine replacement therapy (NRT). When a nicotine patch is used in combination with a second form of NRT, such as a nasal spray, gum or lozenges, cessation rates increase. Smokers are much less likely to quit if only a patch is used.
The study is published in the Cochrane Database of Systematic Reviews, and it is hoped that the findings will enable healthcare workers to offer smokers more effective tools to stop smoking.
Smoking remains the leading cause of preventable disease and death worldwide; however, quitting can be difficult. The effectiveness of smoking cessation products and medicines has remained unclear, making it hard for both smokers themselves and healthcare workers to make informed choices about which therapies will help the most.
In addition, due to manufacturing issues, there is a global shortage of smoking cessation medicines, varenicline and cystisine. The drugs are currently unavailable in many parts of the world, including the UK and Europe, South Africa, Japan and North America.
The researchers reviewed data from over 300 clinical trials which involved over 150,000 people. Using a statistical technique known as Component Network Meta-Analysis (CNMA), they could compare smoking cessation methods against each other using direct comparison within trials and indirect comparisons across trials to assess their relative effectiveness.
E-cigarettes were the most effective way to quit smoking, with 14 in 100 people quitting long-term (going at least six months without a cigarette). Without smoking cessation aids or medications, the long-term quitting rate was 6 in 100.
Using only one type of NRT, such as a nicotine patch, was less effective than e-cigarettes, with 9 in 100 people quitting over the long term. By combining patches with a second form of NRT, 12 in 100 people managed to stop long-term, making them almost as effective as e-cigarettes.
Smoking cessation medications were similarly effective as e-cigarettes.
Dr Jamie Hartmann-Boyce, co-author of the study who was based at the University of Oxford during the research and is now Assistant Professor at the University of Massachusetts Amherst, said: ‘In sifting through extensive data, we’ve gained valuable insights into effective smoking cessation methods. Our findings provide clear evidence of the effectiveness of nicotine e-cigarettes and combination nicotine replacement therapies to help people quit smoking.’
She added: ‘The evidence also is clear on the benefits of medicines cytisine and varenicline, but these may be harder for some people to access at the moment. The best thing someone who smokes can do for their health is to quit smoking, and evidence shows that using varenicline, cytisine, or nicotine e-cigarettes in combination with behavioural support will give them the best chances of successfully doing so.’
The researchers hope the findings will be used to reshape health policy and strategies and enable healthcare workers to offer smokers the most effective tools to quit smoking.