Comparative Effectiveness of 5 Smoking Cessation Pharmacotherapies in Primary Care Clinics

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Abstract
Tobacco use continues to be a significant health threat, with approximately 438 000 smoking-related deaths occurring annually in the United States.1 However, substantial progress has been made in the last 40 years in reducing smoking prevalence from 42.4% in 1965 to 20% in 2007.2,3 In part, these declines are the result of the development of effective cessation treatments. For example, meta-analyses of 86 cessation medication studies in the US Public Health Service (PHS) clinical practice guideline Treating Tobacco Use and Dependence: 2008 Update4 (hereafter, 2008 PHS Guideline) confirmed the efficacy of all 7 Food and Drug Administration (FDA)-approved medications as well as nortriptyline hydrochloride, clonidine, and various combination therapies (eg, bupropion hydrochloride sustained release [SR] + nicotine patch). Yet, most data on cessation pharmacotherapies come from placebo-controlled efficacy trials conducted under ideal circumstance (eg, with motivated volunteers, inducements for participation, extensive participant contact), with few directly contrasting multiple pharmacotherapies in head-to-head comparisons. Even fewer studies have conducted such head-to-head tests in real-world clinic settings.4