title: Effectiveness of varenicline versus nicotine replacement therapy for smoking cessation with minimal professional support: evidence from an English population study.
abstract: BACKGROUND
  Limited evidence from randomised controlled trials suggests that varenicline might be more effective than nicotine replacement therapy (NRT) in achieving abstinence from smoking. The comparative effectiveness of varenicline when prescribed under routine circumstances and in the general population has not been tested.
  
  
  OBJECTIVE
  To compare the abstinence rates of smokers trying to stop having used varenicline vs. NRT on prescription (Rx) when provided with minimal professional support in the general population while adjusting for key potential confounders.
  
  
  METHODS
  A large survey of a representative sample of the English population. Participants were 1,579 adults who smoked within the previous 12 months and made at least one quit attempt with 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 urges to smoke. A sensitivity analysis was conducted in subsamples in which the quit attempt started up to 6 months or more than 6 months ago.
  
  
  RESULTS
  The adjusted odds of abstinence in users of varenicline were 1.76 (95 % CI = 1.22-2.53) times higher compared with users of NRT Rx. However, there was no detectable difference in the subsample of smokers who started their quit attempt more than 6 months ago (adjusted OR = 1.03, 95 %CI = 0.54-1.96).
  
  
  CONCLUSIONS
  Varenicline use with minimal professional support in the general population of smokers appears more effective than NRT Rx in achieving short-term abstinence. However, this effect may disappear in the long-term. Research is needed to confirm this and establish what may underlie it.
authors.affiliation: Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 6BT, UK, d.kotz@maastrichtuniversity.nl.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kotz
authors.forename: Jamie
authors.initials: J
authors.lastname: Brown
authors.forename: Robert
authors.initials: R
authors.lastname: West
mesh_terms: D000328:Adult; D000368:Aged; D001552:Benzazepines / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003625:Data Collection; D003627:Data Interpretation, Statistical; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000627:therapeutic use*; D018722:Nicotinic Agonists / Q000627:therapeutic use*; D011153:Population; D055553:Prescription Drugs; D011810:Quinoxalines / Q000627:therapeutic use*; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000379:methods*; D016896:Treatment Outcome; D000068580:Varenicline
chemical_list: D001552:Benzazepines; D018722:Nicotinic Agonists; D055553:Prescription Drugs; D011810:Quinoxalines; D009538:Nicotine; D000068580:Varenicline