Personalized and adaptive interventions for smoking cessation: Emerging trends and determinants of efficacy

Cigarette smoking addiction is a leading cause of morbidity and mortality and presents a challenging interventional target. Interventions for stopping smoking offer trade-offs in ability to displace or blunt the effects of cigarettes, which include positive and negative reinforcement, psychological reward, aversiveness, and sensory enjoyment, and which are mediated through nicotine and non-nicotine elements of smoking. Established therapies, which include nicotine replacement therapies (NRTs), varenicline, and bupropion are being supplemented with a growing evidence base for cytisine and nicotine substitution products, with more rapid acting NRTs on the horizon, all of which are expanding individual choice. An understanding of determinants of efficacy can inform a personalized and adaptive approach to smoking cessation, which presents an opportunity to further improve outcomes. This includes tailoring cessation treatment plans based on initial individual response, preference, and tolerability to first line interventions and considering second-line options (including evidence-based combination therapies) when needed.