Breaking the habit: comparative effectiveness of smoking cessation therapies in a cardiovascular hospital based clinical setting
E Georgousi, N Ioakeimidis, I Dima, D Terentes-Printzios, D Manos, P Alexiou, A Angelis, D Kalfoutzos, K Tsioufis, C VlachopoulosAbstract
Objective
Nicotine addiction represents a challenging interventional target. Pharmacotherapy helps reduce nicotine withdrawal symptoms and/or minimizes the favourable effects experienced while smoking. Aim of this study is to retrospectively quantify the differences in the likelihood of successful quitting according to the type of pharmacological aid used.
Methods
Data from 169 smokers motivated to quit (51.5±9 years,58% males) with a mean tobacco exposure of 40.2 pack-years who visited our Smoking Cessation Unit were analyzed. Based on the individualized medical and smoking history and personal preference they received a brief counselling and pharmacotherapy with buproprion (n=52), varenicline (n=38) and Nicotine Replacement therapy (NRTs, n=38) by using a 12-week treatment schedule and cytisinicline (n=41) by using the standard 25-day titration treatment schedule. Smoking status was assessed at 12 weeks. The level of nicotine dependence was estimated with Fagerström test (FTND). FTND ≥7 indicates strong nicotine dependence.
Results
At the end of each treatment arm, no serious adverse effect was observed. At 12 weeks, 58% of participants were abstinent. Compared to participants reporting abstinence, the subjects who continued smoking at 12 weeks had higher FTND and tobacco exposure (all p<0.001). In the whole study population the history of cardiovascular disease (CVD) and the type of pharmacological treatment were positively associated with smoking abstinence while high FTND and a greater exposure (>40 pack-years) were negatively associated with successful quitting (all p<0.05). Age and gender were not associated with smoking abstinence (p>0.1). Among individuals in each treatment arm, smoking abstinence rates were 68.2 %, 65.7 %, 52% and 46% for cytisinicline, varenicline, bupropion and NRT respectively. A regression model was used to estimate the odds of successful quitting with cytisinicline, varenicline and bupropion therapy by using NRTs as control arm after adjusting for history of CVD, pack-years and degree of dependence (figure). The analysis showed that cytisinicline (OR = 3.42, 95% CI 1.23–9.48, p = 0.018) and varenicline (OR = 4.46, 95% CI 1.51–13.16, p = 0.007) significantly increased the likelihood of smoking abstinence compared to NRT while the relevant association in bupropion therapy was not significant (p = 0.277).
Conclusion
Among pharmacological treatments, partial agonists of the α4β2 nicotinic receptors (cytisinicline, varenicline) demonstrated higher cessation rates compared with NRTs. Our study also suggest that patients diagnosed with CVD were more inclined to attempt tobacco abstinence, while individuals with a greater tobacco exposure and stronger nicotine dependence were more likely to continue smoking. Further research is needed to optimize treatment efficacy and tailor interventions for diverse populations, particularly high-risk CVD patients and individuals with severe nicotine addictionNon-nicotine therapies and Smoking cessation