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 ( 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.