Abstract
Tobacco use is the single largest preventable cause of death in the United States (US). The national goal of reducing the prevalence of adult cigarette smoking to 12% was retained for 20 years due to non-attainment. Meanwhile, varenicline and electronic cigarettes (ECs) became available in the US in 2006 and 2007, respectively, and have been used by many smokers wanting to quit. The purpose of this review is to compare varenicline and ECs in terms of efficacy for smoking cessation after over a decade of widespread use in the US.Data collection for systematic review and qualitative synthesis by a PubMed search using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelinesand the Oxford Quality Scale, respectively, was performed in June 2018 and updated in June 2020. Articles were eligible if published in English as original research in the form of a randomized clinical trial (RCT), a systematic review and meta-analysis, a systematic review, or a cross-sectional study.Eighteen studies were included: nine RCTs, four cross-sectional studies, two meta-analyses, one systematic review, one systematic review and meta-analysis, and one cohort study. No head-to-head RCT compared varenicline to ECs. In four RCTs, varenicline was more effective than placebo for smoking cessation. In two RCTs, ECs were more effective than placebo but a meta-analysis of 20 studies reported a statistically significant decrease in the odds of quitting smoking using ECs as compared to placebo.To conclude, varenicline and ECs have data suggesting efficacy for smoking cessation; however, unlike varenicline, ECs were not effective in all studies.
Highlights
BackgroundSmoking cost the United States (US) $169 billion in annual healthcare expenditures by 2010 [1] and was the leading cause of death in 2000 [2]
The updated literature search generated an additional three articles, two of which were appropriate for the synthesis; one other paper was identified from the reference list of one of these two papers, and yet another paper from the reference list of the third included paper - so four papers in all were included based on the updated search
Based on the Oxford Quality Scale [30] used to assess the quality of the randomized clinical trial (RCT) reviewed, the overall average quality ratings for the RCTs fall in the medium to high range
Summary
BackgroundSmoking cost the United States (US) $169 billion in annual healthcare expenditures by 2010 [1] and was the leading cause of death in 2000 [2]. Several clinician-level and community-level interventions remain in effect: bans on smoking in public places, high cigarette taxes, restriction on tobacco sales to minors, and a Public Health Service (PHS) guideline that recommends tobacco dependence be considered a chronic condition that requires repeated intervention [5,7]. Population-based research shows that most smokers who report making quit attempts do so without the benefit of recommended counseling and pharmacotherapy [5,9]. Guideline-compliant counseling includes the 5As - ask, advise, assess, assist, and arrange follow-up - and implies a discussion of best/evidence-based methods of quitting tobacco use; varenicline, bupropion, and nicotine replacement therapy (NRT) are the first-line medications recommended by the PHS.
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