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

PLoS One. 2016 Nov 28;11(11):e0166992. doi: 10.1371/journal.pone.0166992. eCollection 2016.

Abstract

Background and objective: Relative 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.

Methods: In 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.

Results: Participants 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.

Conclusions: In 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.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Smoking / drug therapy*
  • Smoking / epidemiology
  • Smoking Cessation / statistics & numerical data*
  • Taiwan / epidemiology
  • Tobacco Use Cessation Devices / statistics & numerical data*
  • Tobacco Use Disorder / prevention & control*
  • Young Adult

Grants and funding

National Yang-Ming University received research funding from the revenues of tobacco health and welfare surcharges by the Health Promotion Administration, Ministry of Health and Welfare, Taiwan, for project, titled “International Collaborative Project for the Evaluation of Medical Services for Smoking Cessation.” Yi-Wen Tsai (PI), Kuang-Chieh Hsueh (Co-PI), Po-Yin Chang, Po-Ching Lo and Hui-Chin Chang received grants (G1031227-105) from the Health Promotion Administration, Ministry of Health and Welfare, Taiwan (http://www.hpa.gov.tw/BHPNet/English/Index.aspx). Health Promotion Administration, Taiwan provided data for the current study; it had no role in study design, analysis, data interpretation, or manuscript writing.