Efficacy of auricular therapy for smoking cessation: A systematic review and network meta-analysis

Abstract

Introduction Tobacco dependence is a chronic disease that increases the risk of multiple diseases. Auricular therapy offers a promising non-pharmacological cessation approach, yet the comparative efficacy of its specific modalities remains unclear. Methods A systematic review and network meta-analysis of randomized controlled trials was conducted within a frequentist framework. The exposure was auricular therapy. The outcomes included exhaled carbon monoxide levels, daily cigarette consumption, smoking cessation rates, nicotine dependence and withdrawal symptoms. Eight databases were searched from inception to 5 February 2026. Two reviewers independently screened, extracted data and assessed the risk of bias. Interventions were compared using league tables of effect sizes with 95% confidence intervals and relative rankings were estimated using surface under the cumulative ranking curve probabilities. Results Thirty-six RCTs involving 3608 participants and 14 interventions were included. Compared with placebo/minimal intervention, auricular acupressure significantly reduced exhaled carbon monoxide (mean difference, MD= -4.67; 95% CI: -6.03 – -3.30), daily cigarette consumption (MD= -6.35; 95% CI: -11.41 – -1.30), nicotine dependence (MD= -2.49; 95% CI: -4.07 – -0.91) and withdrawal symptoms (MD= -6.70; 95% CI: -9.68 – -3.71), and significantly increased smoking cessation rates (OR =4.97; 95% CI: 2.65–9.30). Body/auricular acupuncture+ aromatherapy significantly reduced daily cigarette consumption (MD= -7.64; 95% CI: -15.15 – -0.12) and nicotine dependence (MD= -2.93; 95% CI: -5.53 – -0.33). Laser auricular acupuncture showed the highest point estimate for cessation (OR=7.15; 95% CI: 3.11–16.45). No statistically significant differences were detected between auricular therapies and standard pharmacotherapy. Conclusions Auricular acupressure was the intervention associated with significant benefits across five outcomes. While these findings suggest the potential of auricular therapies as non-pharmacological alternatives, most comparisons relied on indirect evidence and several top-ranked interventions were supported by limited data. Direct head-to-head trials are needed to confirm these observations.