Among smokers, no significant differences were found in biochemically confirmed rates of smoking abstinence at 26 weeks regarding use of three methods of medication-based cessation, according to research published in JAMA.

In a study of 1,086 smokers participating between May 2012 and November 2015, researchers compared the efficacy of varenicline, combination nicotine replacement therapy (C-NRT), and the nicotine patch.

Smoking cessation medications are routinely used in health care; it is vital to identify medications that most effectively treat this leading cause of preventable mortality,” wrote study author Timothy B. Baker, PhD, of the Center for Tobacco Research and Intervention and the Department of Medicine at the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues.

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The 3-group, intention-to-treat clinical trial randomized patients to 1 of 3 12-week open label pharmacotherapy groups. The first group was given only a nicotine patch (n = 241). The second group used only varenicline (n = 424), and the third group was given combination nicotine replacement therapy (C-NRT) comprised of a nicotine patch and nicotine lozenge (n = 421). All participants were offered 6 counseling sessions.

All medications were well tolerated by the participants. At 26 weeks, risk differences for abstinence were -0.76% for the patch versus varenicline, -4% for the patch versus C-NRT, and -3.3% for varenicline versus C-NRT.

The investigators found that varenicline produced more frequent adverse events compared with the nicotine patch for vivid dreams, insomnia, nausea, constipation, sleepiness, and indigestion.

“Among adults motivated to quit smoking, 12 weeks of open label treatment with nicotine patch, varenicline, or C-NRT produced no significant differences in biochemically confirmed rates of smoking abstinence at 26 weeks,” concluded Dr Baker. “The results raise questions about the relative effectiveness of intense smoking pharmacotherapies.”


  1. Baker TB, Piper ME, Stein JH, et al. Effects of nicotine patch vs varenicline vs combination nicotine replacement therapy on smoking cessation at 26 weeks. A randomized clinical trial. JAMA. 2016;315(4):371-379. doi: 10.1001/jama.2015.19284