Comparison of Allen Carr's Easyway programme with NHS-standard specialist cessation support: a randomised controlled trial

This is the peer reviewed version of the following article: Frings D, Albery IP, Moss AC, et al. Comparison of Allen Carr's Easyway programme with a specialist behavioural and pharmacological smoking cessation support service: a randomized controlled trial. Addiction. 2020;115(5):977-985. which has been published in final form at 10.1111/add.14897. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. Background and Aims A combination of behavioural and pharmacological support is judged to be the optimal approach for assisting smoking cessation. Allen Carr’s Easyway (ACE) is a single-session pharmacotherapy-free programme that has been in operation internationally for 38 years. We compared the effectiveness of ACE with specialist behavioural and pharmacological support delivered to the national standard in England. Design A two-arm, parallel-group, single blind, randomised controlled trial. Setting London, UK, between February 2017 and May 2018. Participants 620 participants (310 in ACE and 310 in the combined behavioural and pharmacological support condition) were included in the analysis. Adult (≥ 18 years) smokers wanting to quit were randomised in a 1:1 ratio. Mean age for the total sample was 40.8 years, with 53.4% being male. Participant baseline characteristics (ethnicity, educational level, number of previous quit attempts, nicotine dependence) were evenly balanced between treatment groups. Intervention and comparator The intervention was the ACE method of stopping smoking. This centres on a 4.5-6 hour session of group-based support, alongside subsequent text messages and top-up sessions if needed. It aims to make it easy to stop smoking by convincing smokers that smoking provides no benefits for them. The comparator was a specialist stop smoking service (SSS) providing behavioural and pharmacological support in accordance with national standards. Measurements The primary outcome was self-reported continuous abstinence for 26 weeks from the quit/quit reset date verified by exhaled breath carbon monoxide measurement <10 ppm. Primary analysis was by intention to treat. Secondary outcomes were: use of pharmacotherapy, adverse events and continuous abstinence up to 4 and 12 weeks. Findings 152 participants did not attend treatment (55 ACE vs 97 SSS, p<0.05). Of those who did attend treatment, 100 completed 6-month measures (23.7% ACE vs 20.7% SSS). Continuous abstinence to 26 weeks was 19.4% (60 out of 310) in the ACE intervention and 14.8% (46 out of 310) in the SSS intervention (risk difference for ACE vs SSS 4.5% [95% CI -1.4% to 10.4%, OR = 1.38]). The Bayes factor for superiority of the ACE condition was 1.24. Conclusion There was no clear evidence of a difference in the efficacies of the Allen Carr’s Easyway (ACE) and specialist smoking cessation support involving behavioural support and pharmacotherapy.