Sex Differences in Varenicline Efficacy for Smoking Cessation: A Meta-Analysis
Sex Differences in Varenicline Efficacy for Smoking Cessation: A Meta-Analysis
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DOI：
10.1093/ntr/ntv207
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发表时间：
2016-05-01
影响因子：
4.7
通讯作者：
Weinberger, Andrea H.
中科院分区：
文献类型：
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作者：
McKee, Sherry A.;Smith, Philip H.;Weinberger, Andrea H.
导语：同时服用安非他酮和尼古丁替代品的女性戒烟率低于男性。目前尚不清楚varenicline对男性和女性是否表现出不同的疗效。本研究的目的是首次对临床试验数据进行全面的荟萃分析，以检验伐伦克林戒烟疗效的性别差异。方法：检索MEDLINE、EMBASE和SouInfo，截至2014年12月31日发表的43篇varenicline戒烟临床试验中，有17篇为低偏倚、随机、双盲、安慰剂对照试验。结果：服用安慰剂的女性戒烟率低于男性(PP-12，CA-24；P<；性行为)。使用varenicline，男性和女性的禁酒率在所有六个结果中都被证明是相似的(例如，PP-12禁酒率在女性和男性中都是53%)。与安慰剂结果相比，varenicline对女性的短期和中期结果(PP-12、CA-12、CA-24；P<；0.05性与药物交互作用)更有效。对于治疗结束的PP，varenicline对女性的有效率高出46%。对于持续戒烟，对女性来说，varenicline的有效率分别为34%(CA-12)和31%(CA-24)。结论：与其他戒烟药物不同，varenicline在女性吸烟者中显示出更好的短期和即时疗效，对1年效果相同。在减少戒烟率中典型的性别差异方面，varenicline可能特别有用。应用：varenicline是目前FDA批准的最有效的戒烟药物，这是第一次证明，在考虑短期结果时，与男性相比，女性对戒烟药物有更好的治疗反应。重要的是，这也是第一次表明，在考虑较长期的一年结果时，女性的戒烟率与男性相似。
Introduction: Women have lower rates of quitting than men with both bupropion and nicotine replacement. It is unknown whether varenicline demonstrates differential efficacy for men and women. The purpose of this study was to conduct the first comprehensive meta-analysis of clinical trial data examining sex differences in the efficacy of varenicline for smoking cessation.Methods: Searching MEDLINE, EMBASE, and PsychINFO, 17 of 43 clinical trials of varenicline for smoking cessation published through December 31, 2014 were low-bias randomized double-blind placebo-controlled trials. Data (n = 6710 smokers, 34% female, n = 16 studies, 96% of available data) was analyzed with Metafor program in R. Outcome endpoints were 7-day point-prevalence (PP) and continuous-abstinence (CA) at week 12 (end of treatment), week 24 (6-month follow-up), and week 52 (12-month follow-up).Results: Using placebo, women were less likely than men to quit (PP-12, CA-24; P < .05 for sex). Using varenicline, similar rates of abstinence for men and women were demonstrated for all six outcomes (eg, PP-12 abstinence rates were 53% in both women and men). Varenicline versus placebo outcomes demonstrated that varenicline was more effective for women for short and intermediate outcomes (PP-12, CA-12, CA-24; P < .05 sex x medication interaction). For end-of-treatment PP, varenicline was 46% more effective for women. For continuous abstinence, varenicline was 34% (CA-12) and 31% (CA-24) more effective for women.Conclusions: Unlike other smoking cessation medications, varenicline demonstrated greater efficacy among women smokers for short and immediate-term outcomes and equal efficacy for 1-year outcomes. Varenicline may be particularly useful for reducing the sex disparity typically seen in rates of smoking cessation.Implications: Varenicline is currently the most effective FDA-approved smoking cessation medication and this is the first demonstration that women compared with men have a preferred therapeutic response for a smoking cessation medication when considering short-term outcomes. Importantly, this is also the first demonstration that women have similar rates of quitting to men when considering longer-term, 1-year outcomes.