Patches, pills, or Puff Bar: Which treatment is best for quitting smoking?

By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada
Staff Research and Content Writer

© Copyright – SUD RECOVERY CENTERS – A Division of Genesis Behavioral Services, Inc.,
Milwaukee, Wisconsin – October 2023 – All rights reserved.

A new systematic review from Cochrane Library found that electronic cigarettes (often called e-cigarettes or vapes) and the medications varenicline and cytisine are the most effective tools to help patients quit smoking.  

Most adults who smoke cigarettes want to quit. In the US, over 70% of adults who currently smoke express interest in quitting in the next 6 months. Unfortunately, only 6% of people who quit smoking are successful. Although there are pharmacological (medicinal) treatments that can help people quit smoking, most people do not use them. Moreover, we do not know which treatments are the best in helping people quit smoking and stay quit long-term.

A new systematic review from Cochrane Library looked at the best available evidence on all approved treatments (nicotine replacement therapy, prescription medications), as well as e-cigarettes, for quitting smoking and compared the evidence for each tool.

The authors wanted to learn:

  • Which treatments help people quit smoking.
  • Which treatments are most effective in helping people quit smoking.
  • What the risks of these treatments are, and which treatments are safest.

What treatments are available to quit smoking?

There are several approved treatments available in the United States to quit smoking. Behavioral support, also known as quit counselling, is a popular service offered by quit lines and health care providers. There are also approved medications including prescription medications and non-prescription Nicotine Replacement Therapy (NRT) products. These medications are recommended by the World Health Organization and approved by the Food and Drug Administration (FDA) as quit-smoking aids. Experts agree that one of the best ways to quit smoking is by combining a medicinal treatment with quit counselling.

More recently, Americans and others around the world have started using e-cigarettes to try to quit smoking. E-cigarettes (also called vapes) were conceptualized as quit-smoking aids but have become most popular among youth who have never smoked. The evidence so far about how well e-cigarettes help people quit smoking has been mixed. There is also a lack of evidence about the long-term health effects of vaping.


What did this study do?

The authors looked at 319 randomized controlled trials in their review, mostly from the US or Europe. Randomized controlled trials are the more reliable type of study because they can show cause and effect between a treatment and its results.The studies that the authors looked at compared various approved quit-smoking treatments with a control condition (no treatment), a placebo (fake) treatment, or other types of quit-smoking medications or treatments.

The authors then compared the treatments from all the studies with each other using a method called network meta-analysis. This lets them determine the overall effect of a treatment. The meta-analysis helped the authors compare treatments to decide which was the most effective at helping people quit smoking.

What were the results of this study?

After comparing the effectiveness and safety of each treatment, the authors concluded:

  • E-cigarettes, varenicline, and cytisine are the treatments most likely to help people quit smoking.
  • Using two forms of Nicotine Replacement Therapy at the same time (called combination therapy) is also effective for quitting smoking.

Based on the available evidence, these treatments are unlikely to cause serious harms.


Other approved treatments including the medication bupropion and single nicotine replacement therapy items (nicotine patches, gum, lozenges, or spray) helped fewer people quit smoking than the top options. However, they were more effective than a placebo or no treatment, so they can still be used with patients.

The authors did not find a lot of evidence about the side effects or potential serious harms of these treatments. In the studies they analyzed, there was not a lot of information about patients experiencing serious harms from any treatment. The only treatment that they found to cause some serious harm was bupropion. But, information could come up in the future that shows serious harms from one of the top-recommended treatments. For now, the authors concluded that from the information they had, very few people were seriously harmed from using these stop-smoking treatments.

What are the key takeaways?

The best treatments for people looking to quit smoking are e-cigarettes with nicotine in them and the medications varenicline and cytisine. The next best treatment is combination Nicotine Replacement Therapy. Based on the available information, these treatments are safe to use. Still, future research should look into the potential health harms and side effects of these treatments.

Health care providers can use this information to help their patients quit smoking. They should recommend that their patients first try e-cigarettes, varenicline, or cytosine to help them quit smoking.


Lindson N, Theodoulou A, Ordóñez-Mena JM, Fanshawe TR, Sutton AJ, Livingstone-Banks J, Hajizadeh A, Zhu S, Aveyard P, Freeman SC, Agrawal S, Hartmann-Boyce J. Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta‐analyses. Cochrane Database of Systematic Reviews 2023, Issue 9. Art. No.: CD015226. DOI: 10.1002/14651858.CD015226.pub2. Accessed 31 October 2023