Cochrane group updates evidence on interventions to combat tobacco addiction

By Melanie Hinze

A newly published high­-quality review provides a timely reminder that there are numerous effective interventions that can help smokers quit, an Australian expert has told Medicine Today.

Professor Stuart Ferguson, Associate Head of Research at the Tasmanian School of Medicine, the University of Tasmania, Hobart, said, ‘While smoking rates have declined in Australia over recent years, there are still many smokers in the community who struggle to quit.’

Published in Addiction, the review, conducted by the Cochrane Tobacco Addiction Group (CTAG), provided an update of all new and updated Cochrane Reviews by the group published between 2021 and 2023. In total, 14 reviews were summarised.

The review authors reported that all main pharmacotherapies (varenicline, cytisine,* bupropion and nicotine replacement therapy, especially when patches were combined with fast-acting forms like gum) were effective for smoking cessation, as were nicotine e­-cigarettes.

Professor Ferguson said these interventions had been shown to be safe and effective across a wide range of trials.

The CTAG also found that among e­-cigarette users, more than half were still using them at six months or more and biomarkers of potential harm were significantly reduced in those switching from smoking to vaping or dual use.

However, the group reported that findings on mindfulness­-based interventions, interventions delivered by dental and primary care professionals, interventions to prevent weight gain after smoking cessation, and interventions for waterpipe cessation were less certain.

Furthermore, observational evidence was reported to show that smoking cessation improved mental health and reduced both cardiovascular events and mortality in those with pre-­existing cardiovascular disease.

The review authors said that further research was needed comparing different dosages and durations, particularly for varenicline and cytisine, testing different combinations of pharmacotherapies, and reporting safely data.

Professor Ferguson noted that, ‘Importantly, the review highlighted that quitting smoking improves mental health; an important point given that smoking is more common among people experiencing mental illness.’

Addiction 2024; 1-15; doi: 10.1111/add.16624.

* In Australia, effective from 1 October 2024, the TGA made an interim decision to create new entries in the Poisons Standards for cytisine in Schedules 3 and 4 as an aid in withdrawal from tobacco smoking.