الإصدار 4 - العدد 11 (2026-02-20)

Comparative Efficacy of Varenicline, Bupropion, and Nicotine Replacement Therapy in Primary Care Smoking Cessation Programs

Researcher: Aida bakry Ibrahim Hussein

University Malaya Center for Addiction (UMCAS)-59200 Kuala Lumpur-Malaysia.

Background:
Smoking cessation is a cornerstone of preventive medicine; nevertheless, tobacco use continues to cause over eight million deaths globally each year (WHO, 2024). Primary care settings represent the most accessible platform for delivering smoking-cessation interventions, where pharmacotherapies such as varenicline, bupropion, and nicotine replacement therapy (NRT) are routinely prescribed. Despite their widespread use, comprehensive comparative evidence regarding their effectiveness, adherence, and real-world implementation in primary care—particularly in the post-COVID-19 era—remains limited.

Objective:
This systematic review aims to synthesise studies published between 2020 and 2025 to compare the effectiveness, adherence, and contextual factors associated with varenicline, bupropion, and NRT in primary-care smoking-cessation programmers using a thematic analysis approach.

Methods:
A PRISMA 2020–guided systematic literature review was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library. Eligible studies included randomized controlled trials, cohort studies, and mixed-methods research involving adult primary-care populations that compared at least two of the three pharmacotherapies. Data were analyzed thematically following the six-phase framework proposed by Braun and Clarke (2006).

Results:
Eighteen studies meeting the inclusion criteria were synthesized. Three overarching themes emerged: (1) pharmacological effectiveness and maintenance of abstinence, (2) patient-centered behavioral support and treatment adherence, and (3) system-level barriers to implementation. Varenicline consistently demonstrated superior long-term cessation outcomes compared with bupropion and NRT. However, sustained abstinence was also strongly influenced by patient adherence and the availability of structured programmed support.

Conclusion:
Between 2020 and 2025, varenicline remained the most effective pharmacotherapy for smoking cessation within primary-care settings. Nonetheless, translating pharmacological efficacy into durable smoking abstinence requires supportive healthcare systems, effective implementation strategies, and integrated behavioral counselling.