pubmed.ncbi.nlm.nih.gov

Efficacy of pharmacotherapies for short-term smoking abstinance: a systematic review and meta-analysis - PubMed

  • ️Thu Jan 01 2009

Efficacy of pharmacotherapies for short-term smoking abstinance: a systematic review and meta-analysis

Edward J Mills et al. Harm Reduct J. 2009.

Abstract

Background: Smoking cessation has important immediate health benefits. The comparative short-term effectiveness of smoking cessation interventions is not well known. We aimed to determine the relative effectiveness of nicotine replacement therapy (NRT), bupropion and varenicline at 4 weeks post-target quit date.

Methods: We searched 10 electronic medical databases (inception to October 2008). We selected randomized clinical trials [RCTs] evaluating interventions for our primary outcome of abstinence from smoking at at-least 4 weeks post-target quit date, with biochemical confirmation. We conducted random-effects odds ratio (OR) meta-analysis and meta-regression. We compared treatment effects across interventions using head-to-head trials and calculated indirect comparisons.

Results: We combined a total of 101 trials evaluating delivery of NRT versus inert controls at approximately 4 weeks post-target quit date (total n = 31,321). The pooled overall OR is OR 2.05 (95% Confidence Interval [CI], 1.89-2.23, P =< 0.0001). We pooled data from 31 bupropion trials contributing a total n of 11,118 participants and found a pooled OR of 2.25 (95% CI, 1.94-2.62, P =< 0.0001). We evaluated 9 varenicline trials compared to placebo. Our pooled estimate for cessation at 4 weeks post-target quit date found a pooled OR of 3.16 (95% CI, 2.55-3.91, P =< 0.0001). Two trials evaluated head to head comparisons of varenicline and bupropion and found a pooled estimate of OR 1.86 (95% CI, 1.49-2.33, P =< 0.0001 at 4 weeks post-target quit date. Indirect comparisons were: NRT and bupropion, OR, 1.09, 95% CI, 0.93-1.31, P = 0.28; varenicline and NRT, OR 1.56, 95% CI, 1.23-1.96, P = 0.0002; and, varenicline and bupropion, OR 1.40, 95% CI, 1.08-1.85, P = 0.01.

Conclusion: Pharmacotherapeutic interventions are effective for increasing smoking abstinence rates in the short-term.

PubMed Disclaimer

Figures

Figure 1
Figure 1

Flow diagram of included studies.

Figure 2
Figure 2

Random effects meta-analysis of all NRT trials combined versus all inert controls at 4 weeks. post-TQD.

Figure 3
Figure 3

Funnel plot evaluating publication bias in NRT versus control event rates at 4 weeks post-TQD.

Figure 4
Figure 4

Random effects meta-analysis of smoking cessation with bupropion versus controls at 4-weeks post-TQD.

Figure 5
Figure 5

Random effects meta-analysis of sustained smoking abstinence with bupropion versus controls at 4-weeks post-TQD.

Figure 6
Figure 6

Random effects meta-analysis of varenicline versus placebo at 4 weeks post-TQD.

Figure 7
Figure 7

Indirect comparisons.

Similar articles

Cited by

References

    1. Peto R, Lopez AD, Boreham J, Thun M, Heath C, Jr, Doll R. Mortality from smoking worldwide. Br Med Bull. 1996;52:12–21. - PubMed
    1. Law M, Tang JL. An analysis of the effectiveness of interventions intended to help people stop smoking. Arch Intern Med. 1995;155:1933–1941. doi: 10.1001/archinte.155.18.1933. - DOI - PubMed
    1. Kuehn BM. Updated US smoking cessation guideline advises counseling, combing therapies. JAMA. 2008;299:2736. doi: 10.1001/jama.299.23.2736. - DOI - PubMed
    1. US Public Health Service. Treating Tobacco Use and Dependence: 2008 Update. 2008. http://www.ahrq.gov/path/tobacco.htm
    1. Silagy C, Lancaster T, Stead L, Mant D, Fowler G. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2004:CD000146. - PubMed

LinkOut - more resources