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Varenicline and cytisine are efficacious aids to smoking cessation. Varenicline is more efficacious than bupropion and a single type of NRT but of similar efficacy to a combination of NRT types.



Varenicline is a nicotine receptor partial agonist. Eleven trials of varenicline for long-term smoking cessation and one of varenicline for relapse prevention are available. In cessation trials, varenicline demonstrated significant effects on long-term abstinence, more than doubling the likelihood of abstinence. In a double-blind, discontinuation trial of varenicline, people who were abstinent at the end of 12 weeks of varenicline therapy and continued on varenicline, had higher 6-month quit rates than abstinent smokers who were switched to placebo at the 12-week time point.

Three trials have compared varenicline to bupropion in a double placebo design. When pooled there was a significantly greater benefit from varenicline. Quit rates amongst people using bupropion were however slightly lower than expected.

Based on a combination of direct and indirect evidence, Varenicline is more effective than a single type of NRT nicotine patch but of similar efficacy to a combination.

Cytisine is a nicotine receptor partial agonist like varenicline. A product containing cytisine, Tabex, has been licensed and used as a smoking cessation aid in some Eastern European countries for more than 40 years. One high quality randomized trial has now shown a statistically and clinically significant effect on 12 month abstinence.



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Cahill K, Stead LF, Lancaster T. Nicotine receptor partial agonists for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD006103. DOI: 10.1002/14651858.CD006103.pub6.

Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009329. DOI: 10.1002/14651858.CD009329.pub2.

Etter JF. Cytisine for smoking cessation: a literature review and a meta-analysis. Arch Intern Med. 2006; 166: 1553-1559.

West R, Zatonski W, Cedzynska M, et al. Placebo-controlled trial of cytisine for smoking cessation. N Engl J Med. 2011; 365(13): 1193-1200.

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