ATTUD Journal Club Postings

Keeping Up on Scientific Data on the Efficacy of Treatments for Smoking

Each year the Cochrane Colloboration publishes an update of all their reviews on smoking (www.thecochranelibrary.com). This is an easy way to check up on new treatment findings and whether any prior findings are no longer thought true. I like the Cochrane because it uses the same methods to test all the treatments and really strives to be unbiased (note I am a un‐reimbursed member of Cochrane Tobacco Addiction Review Group). This year’s summary (Hartmann‐Boyce et al, Addiction, epub ahead of print) includes 2 new reviews an 11 updates. Table 2 is a great way to see all the treatments and their results in controlled trials. Also, if you want to look at an individual Cochrane review, I suggest you only need to look at the Abstract, the Plain Language Summary of Findings and the table “Summary of Findings for the Main Comparison” – all are 1‐2 pages and at top of the article. The major findings of this year’s new and revised reviews are:

  • Mood management increases quitting among smokers with current or past depression (yes that’s even in currently depressed smokers.)
  • Varenicline and combined patch + ad lib NRT are the two most effective medication treatments and are better than single NRT or bupropion.
  • Evidence is insufficient to say varenicline, bupropion or NRT produce medical or psychiatric serious adverse events.
  • Counseling can increase cessation in pregnant enough to improve perinatal outcomes.
  • Cytisine (a varenicline‐like medication) appears to be as effective as varenicline and , if found safe and licensed could be 1/5th to 10th the cost of varenicline.
  • None of the prior positive findings were refuted by new evidence.
  • Calls for more research on internet treatments, adolescents, those with schizophrenia and for long‐term observational trials of varenicline to examine adverse events.