Do the Benefits of Smoking Cessation Tx Decrease Over Time?

Benefits of smoking cessation medications decline over the first year.

According to a new study published in Addiction, only 8% of smokers continued to benefit from smoking cessation treatment after taking these medications for 1 year.

To investigate whether the benefits of smoking cessation medications decreased over time, researchers from Tel Aviv University (TAU) identified studies from 3 systematic reviews that included randomized controlled trials of first-line smoking cessation medications with 6- and 12-month follow-up. Rates of sustained abstinence (SA) at 6 vs 12 months and 3 vs 6 months were also analyzed. 

A total of 61 studies involving 27,647 patients were included. The authors found <40% of participants had SA at 3 months (bupropion 37.1%; nicotine replacement therapy [NRT] 34.8%; varenicline 39.3%) and about 25% of participants had SA at 6 months (bupropion: 25.9%; NRT: 26.6%; varenicline: 25.4%). 

At 12 months, approximately one-fifth of participants in the intervention group had SA (bupropion 19.9%; NRT 19.8%; varenicline 18.7%). A small decline in relative risk (RR) was seen at 3 months (1.95, 95% CI: 1.74–2.18; P<0.0001), 6 months (1.87, 95% CI: 1.67–2.08; P<0.0001), and 12 months (1.75, 95% CI: 1.56–1.95; P<0.0001) between intervention and control groups over time, but there was a substantial decline in net benefit. 

This decline in net benefit was found to be statistically significant between 3 and 6 months (risk difference [RD] 4.95%, 95% CI: 3.49–6.41; P<0.0001) and between 6 and 12 months (RD 3.00%, 95% CI: 2.36–3.64; P<0.0001) for combination vs. single medications. 

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“Less than 40% of those receiving the medications continued to abstain from smoking after 3 months, about 25% had still quit after 6 months, and about only a fifth — 20% — remained abstinent after a full year,” said lead author Dr. Laura J. Rosen of the School of Public Health at TAU’s Sackler Faculty of Medicine. “Importantly, 12% of those who did not receive active medication continued to abstain from smoking after 1 year. Because benefit is calculated by starting with the quit rate among those who received the medication, and subtracting from the percentage who quit in the groups which didn’t receive the medication, just 8% of smokers who received smoking cessation medications continued to benefit from the drugs after one year.”

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