# Real-world effectiveness of cytisine, bupropion, and nicotine replacement therapy in a smoking cessation clinic: A single-center retrospective cohort study

## TL;DR

This study compares the real-world effectiveness of cytisine, bupropion, and nicotine replacement therapy in helping patients quit smoking in a clinic setting.

## Contribution

The study provides real-world evidence on the effectiveness of cytisine, bupropion, and NRT in a smoking cessation outpatient clinic.

## Key findings

- Cytisine was associated with higher smoking cessation success compared to bupropion and NRT.
- Treatment adherence was a key determinant of successful smoking cessation.
- Relapse occurred in about one-third of patients who achieved initial abstinence.

## Abstract

Pharmacological treatments such as cytisine, bupropion, and nicotine replacement therapy (NRT) are widely used to support smoking cessation. However, evidence comparing their effectiveness in real-world clinical settings, particularly within smoking cessation outpatient clinics, remains limited.

This retrospective cohort study evaluated smoking cessation outcomes among patients attending a tertiary smoking cessation outpatient clinic, with follow-up assessments conducted at approximately the first, third, and sixth months. The study was conducted between 1 January 2024 and 28 March 2025. Participants received cytisine, bupropion, or NRT in combination with standardized behavioral counseling. Demographic variables, smoking-related characteristics, treatment adherence, adverse effects, and cessation outcomes were assessed. Smoking cessation was defined as self-reported abstinence during follow-up. Adult patients aged ≥18 years who received smoking cessation treatment were included in the study.

A total of 113 patients were included, of whom 67 (59.3%) successfully quit smoking. Completion of pharmacological treatment was significantly higher among patients who quit smoking compared with those who did not (77.6% vs 30.4%, p<0.001). Cytisine use was more frequent among patients who achieved smoking cessation (58.2% vs 39.1%, p=0.046), whereas bupropion use was higher among those who failed to quit smoking (41.3% vs 20.9%, p=0.019). Nicotine replacement therapy use was not significantly associated with cessation outcomes (p=0.983). Among patients who achieved abstinence, relapse occurred in approximately one-third during follow-up. Improvement in dyspnea was reported more frequently among cytisine users.

In this real-world outpatient setting, cytisine was associated with higher smoking cessation success compared with bupropion and NRT. Treatment adherence emerged as a key determinant of cessation outcomes.