Prospective cohort study of the effectiveness of varenicline versus nicotine replacement therapy for smoking cessation in the "real world"

Background: It is important to know the comparative effectiveness of varenicline and nicotine replacement therapy (NRT) for smoking cessation when prescribed under routine circumstances and in the general population. Previous estimates relied on cross-sectional data. The objective of the current study was to use longitudinal data to compare the abstinence rates of smokers trying to stop having used varenicline versus NRT on prescription (Rx) when provided with minimal professional support in the general population while adjusting for key potential confounders. Methods: Prospective cohort study in 270 adults who participated in a household survey, smoked at baseline, responded to the 6-month follow-up survey, and made at least one quit attempt between the two measurements with either varenicline or NRT Rx in their most recent quit attempt. The main outcome measure was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including cigarette dependence (measured at baseline). Results: Users of varenicline were younger, reported more time spent with urges to smoke at baseline, and were less likely to stop abruptly during their last quit attempt (all p < 0.01). The adjusted odds of abstinence in users of varenicline were 3.83 (95% CI = 1.88-7.77) times higher compared with users of NRT Rx. Conclusions: Varenicline use with minimal professional support in the general population of smokers appears more effective than NRT Rx in achieving abstinence.