Antidepressants for smoking cessation

Hughes, John R.; Stead, Lindsay F; Hartmann‐Boyce, Jamie; Cahill, Kate; Lancaster, Tim

doi:10.1002/14651858.cd000031.pub4

Cited by 240 publications

(219 citation statements)

References 325 publications

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“…However, the RD is used far less often than the RR or the OR. Cochrane Reviews generally present RRs in the results of smoking cessation medication reviews 6, 7, 8, while NICE 9 and others 10, 11, 12, 13 present ORs. The European guideline on cardiovascular disease prevention describes relative benefit based on the OR: ‘Overall, NRT and bupropion help ∼80% more people to quit than placebo’ (26, p. 92).…”

Section: Introductionmentioning

confidence: 99%

“…The effectiveness of US FDA‐recommended first‐line smoking cessation medications 5 is undisputed when considering evidence from randomized controlled trials (RCTs). Systematic reviews and meta‐analyses conducted by the Cochrane Collaboration 6, 7, 8, the US Public Health Services, 5 England's National Institute for Health and Care Excellence (NICE) 9 and others 10, 11, 12, 13 show consistently that smoking cessation medications help smokers quit.…”

Section: Introductionmentioning

confidence: 99%

“…Original reports of studies often describe quit rates at a single time‐point, with 6 months used as a standard, on the grounds that it is possible to ‘make reliable estimates of permanent cessation’ on the basis of 6‐month continued abstinence 23. Reviews and meta‐analyses usually provide a single summary measure based on quit rates at a single time‐point, or as a summary based on several time‐points (Cochrane Reviews: 6 months or more, 6–24 months 6, 7, 8; the US Public Health Service: 6 months 5; independent reviewers: 6 or 12 months 10, 12.). Representing smoking cessation at a single or composite time‐point obscures the more complex reality of declining quit rates: neither the benefit to an individual as time progresses nor to a population is easily grasped.…”

Section: Introductionmentioning

confidence: 99%

“…Representing smoking cessation at a single or composite time‐point obscures the more complex reality of declining quit rates: neither the benefit to an individual as time progresses nor to a population is easily grasped. The problem is compounded because few studies continue beyond 1 year 6, 7, 8.…”

Section: Introductionmentioning

confidence: 99%

“…The European guideline on cardiovascular disease prevention describes relative benefit based on the OR: ‘Overall, NRT and bupropion help ∼80% more people to quit than placebo’ (26, p. 92). Information on the percentage of people who benefit from treatment is often absent 26 or unclear 7, 8.…”

Section: Introductionmentioning

confidence: 99%

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Diminishing benefit of smoking cessation medications during the first year: a meta‐analysis of randomized controlled trials

et al. 2018

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Background and aimsAlthough smoking cessation medications have shown effectiveness in increasing abstinence in randomized controlled trials (RCTs), it is unclear to what extent benefits persist over time. This paper assesses whether the benefits of smoking cessation medications decline over the first year.MethodsWe selected studies from three systematic reviews published by the Cochrane Collaboration. RCTs of first‐line smoking cessation medications, with 6‐ and 12‐month follow‐up, were eligible for inclusion. Meta‐analysis was used to synthesize information on sustained abstinence (SA) at 6 versus 12 months and 3 versus 6 months, using the risk difference (RD) (‘net benefit’) between intervention and control group quit rates, the relative risk (RR) and the odds ratio (OR).ResultsSixty‐one studies (27 647 participants) were included. Fewer than 40% of intervention group participants were sustained abstinent at 3 months (bupropion: 37.1%; nicotine replacement therapy (NRT): 34.8%; varenicline: 39.3%); approximately a quarter were sustained abstinent at 6 months (bupropion: 25.9%; NRT: 26.6%; varenicline: 25.4%), and approximately a fifth were sustained abstinent at 12 months (bupropion: 19.9%; NRT: 19.8%%; varenicline: 18.7%). There was only a small decline in RR (3 months: 1.95 [95% confidence interval (CI) = 1.74–2.18, P < 0.0001]; 6 months: 1.87 (95% CI = 1.67–2.08 P < 0.0001); 12 months: 1.75 (95% CI = 1.56–1.95, P < 0.0001) between intervention and control groups over time, but a substantial decline in net benefit [3 months: RD = 17.3% (14.5–20.1%); 6 months: RD = 11.8% (10.0–13.7%); 12 months: RD = 8.2% (6.8–9.6%)]. The decline in net benefit was statistically significant between 3 and 6 [RD = 4.95% (95% CI = 3.49–6.41%), P < 0.0001] and 6 and 12 months [RD = 3.00% (95% CI = 2.36%–3.64%), P < 0.0001)] for medications combined and individual medications.ConclusionsThe proportion of smokers who use smoking cessation medications who benefit from doing so decreases during the course of the first year, but a net benefit still remains at 12 months.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diminishing benefit of smoking cessation medications during the first year: a meta‐analysis of randomized controlled trials

et al. 2018

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Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons

Force¹,

Krist

Davidson

et al. 2021

JAMA

305

139

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IMPORTANCE Tobacco use is the leading preventable cause of disease, disability, and death in the US. In 2014, it was estimated that 480 000 deaths annually are attributed to cigarette smoking, including second hand smoke exposure. Smoking during pregnancy can increase the risk of numerous adverse pregnancy outcomes (eg, miscarriage and congenital anomalies) and complications in the offspring (including sudden infant death syndrome and impaired lung function in childhood). In 2019, an estimated 50.6 million US adults (20.8% of the adult population) used tobacco; 14.0% of the US adult population currently smoked cigarettes and 4.5% of the adult population used electronic cigarettes (e-cigarettes). Among pregnant US women who gave birth in 2016, 7.2% reported smoking cigarettes while pregnant.OBJECTIVE To update its 2015 recommendation, the USPSTF commissioned a review to evaluate the benefits and harms of primary care interventions on tobacco use cessation in adults, including pregnant persons.POPULATION This recommendation statement applies to adults 18 years or older, including pregnant persons. EVIDENCE ASSESSMENTThe USPSTF concludes with high certainty that the net benefit of behavioral interventions and US Food and Drug Associated (FDA)-approved pharmacotherapy for tobacco smoking cessation, alone or combined, in nonpregnant adults who smoke is substantial. The USPSTF concludes with high certainty that the net benefit of behavioral interventions for tobacco smoking cessation on perinatal outcomes and smoking cessation in pregnant persons is substantial. The USPSTF concludes that the evidence on pharmacotherapy interventions for tobacco smoking cessation in pregnant persons is insufficient because few studies are available, and the balance of benefits and harms cannot be determined. The USPSTF concludes that the evidence on the use of e-cigarettes for tobacco smoking cessation in adults, including pregnant persons, is insufficient, and the balance of benefits and harms cannot be determined. The USPSTF has identified the lack of well-designed, randomized clinical trials on e-cigarettes that report smoking abstinence or adverse events as a critical gap in the evidence. RECOMMENDATIONSThe USPSTF recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and FDA-approved pharmacotherapy for cessation to nonpregnant adults who use tobacco. (A recommendation) The USPSTF recommends that clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant persons who use tobacco. (A recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of pharmacotherapy interventions for tobacco cessation in pregnant persons. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of e-cigarettes for tobacco cessation in adults, including pregnant ...

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