Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials
Pharmacotherapies for smoking cessation: a meta-analysis of randomized controlled trials
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DOI：
10.1503/cmaj.070256
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发表时间：
2008-07-15
影响因子：
14.6
通讯作者：
Pilote, Louise
中科院分区：
文献类型：
--
作者：
Eisenberg, Mark J.;Filion, Kristian B.;Pilote, Louise
背景：许多安慰剂对照试验已经证明了个别药物治疗被批准用于戒烟的有效性。然而，很少对这些干预措施进行直接或间接的比较。我们进行了一项荟萃分析，比较了7种经批准的戒烟药物干预措施的治疗效果。方法：我们检索了美国疾病控制和预防中心的烟草信息和预防数据库，以及MEDLINE、EMBASE和Cochrane图书馆，以获取已发表的关于药物治疗戒烟的安慰剂对照、双盲随机对照试验的报告。我们纳入的研究报告了6个月和12个月的生物化学验证禁欲措施。我们使用分层贝叶斯随机效应模型来总结每种干预措施的结果。结果：我们确定了69项试验的70篇已发表的报告，共涉及32 908名患者。研究发现7种药物治疗中有6种比安慰剂更有效：伐尼克兰（优势比[OR] 2.41, 95%可信区间[CrI] 1.91-3.12）、尼古丁鼻喷雾剂（OR 2.37, 95% CrI 1.12-5.13）、安非他酮（OR 2.07, 95% CrI 1.73-2.55）、透皮尼古丁（OR 2.07, 95% CrI 1.69-2.62）、尼古丁片（OR 2.06, 95% CrI 1.12-5.13）和尼古丁口香糖（OR 1.71, 95% CrI 1.35-2.21）。无论采用哪种禁欲方法，都得到了相似的结果。虽然点估计更倾向于尼古丁吸入器而不是安慰剂（OR 2.17），但由于可信区间包括统一（95% CrI 0.95-5.43），这些结果并不是结论性的。当所有7种干预措施被纳入同一模型时，所有干预措施都比安慰剂更有效。在我们对包括安非他酮对照组的伐尼克兰试验数据的分析中，我们发现伐尼克兰优于安非他酮（OR 2.18, 95% CrI 1.09-4.08）。结论：在6个月和12个月时，伐尼克兰、安非他酮和5种尼古丁替代疗法在促进戒烟方面都比安慰剂更有效。
Background: Many placebo-controlled trials have demonstrated the efficacy of individual pharmacotherapies approved for smoking cessation. However, few direct or indirect comparisons of such interventions have been conducted. We performed a meta-analysis to compare the treatment effects of 7 approved pharmacologic interventions for smoking cessation.Methods: We searched the US Centers for Disease Control and Prevention's Tobacco Information and Prevention database as well as MEDLINE, EMBASE and the Cochrane Library for published reports of placebo-controlled, double-blind randomized controlled trials of pharmacotherapies for smoking cessation. We included studies that reported biochemically validated measures of abstinence at 6 and 12 months. We used a hierarchical Bayesian random-effects model to summarize the results for each intervention.Results: We identified 70 published reports of 69 trials involving a total of 32 908 patients. Six of the 7 pharmacotherapies studied were found to be more efficacious than placebo: varenicline ( odds ratio [ OR] 2.41, 95% credible interval [ CrI] 1.91-3.12), nicotine nasal spray ( OR 2.37, 95% CrI 1.12-5.13), bupropion ( OR 2.07, 95% CrI 1.73-2.55), transdermal nicotine ( OR 2.07, 95% CrI 1.69-2.62), nicotine tablet ( OR 2.06, 95% CrI 1.12-5.13) and nicotine gum ( OR 1.71, 95% CrI 1.35-2.21). Similar results were obtained regardless of which measure of abstinence was used. Although the point estimate favoured nicotine inhaler over placebo ( OR 2.17), these results were not conclusive because the credible interval included unity ( 95% CrI 0.95-5.43). When all 7 interventions were included in the same model, all were more efficacious than placebo. In our analysis of data from the varenicline trials that included bupropion control arms, we found that varenicline was superior to bupropion (OR 2.18, 95% CrI 1.09-4.08).Interpretation: Varenicline, bupropion and the 5 nicotine replacement therapies were all more efficacious than placebo at promoting smoking abstinence at 6 and 12 months.