Review: Nicotine gum and varenicline, but not behavioral interventions, reduce relapse in persons who have stopped smoking

In persons who stop smoking, which interventions prevent relapse?

Included studies evaluated behavioral and pharmacologic interventions for relapse prevention (RP) in persons who had stopped smoking on their own or with treatment and those who had enforced abstinence (e.g., because of pregnancy, hospitalization, or military training). Studies randomized current smokers or those who had stopped smoking before randomization (abstainers). Exclusion criteria for studies of current smokers were exercise or aversive smoking interventions, hospitalized populations, or lack of explicit focus on RP unless there was extended telephone follow-up after initial cessation. Outcome was proportion of persons not smoking at ≥ 6 months.

Cochrane Tobacco Addiction Group trial register (Aug 2008) was searched for randomized controlled trials (RCTs) or quasi-RCTs with ≥ 6 months of follow-up. 54 trials met the selection criteria: 36 randomized abstainers, 17 randomized current smokers, and 1 randomized both.

Abstainers. The main results are shown in the Table. Nicotine gum was effective (Table), and 1 trial of persons (n = 1210) who stopped smoking with treatment found that extended use of varenicline was better than placebo for continued smoking cessation at 12 months (44% vs 37%, relative benefit [RB] increase 18%, 95% CI 3 to 36, number needed to treat 16, 95% CI 8 to 91). Current smokers. Adding behavioral RP components to cessation interventions did not improve smoking cessation at longest follow-up (10 trials with time-matched interventions, n = 872, 24% vs 27%, RB reduction 9%, CI −13 to 27).

Varenicline and nicotine gum reduce relapse in persons who have stopped smoking; behavioral interventions do not reduce risk for relapse.