Pharmacological interventions on smoking cessation: A systematic review and network meta-analysis

Abstract

Objective: A network meta-analysis based on randomized controlled trials was conducted to investigate the effects of pharmacological interventions on smoking cessation.Methods: English databases were searched to obtain randomized controlled trials reporting the effect of pharmacological interventions on smoking cessation. The risk of bias for the included trials was assessed using Cochrane Handbook tool. Stata 15.1 software was used to perform network meta-analysis, and GRADE approach was used to assess the evidence credibility on the effects of different interventions on smoking cessation.Results: A total of 159 studies involving 60,285 smokers were included in the network meta-analysis. The analysis involved 15 interventions and which yielded 105 pairs of comparisons. Network meta-analysis showed that varenicline was more helpful for smoking cessation than other monotherapies, such as nicotine replacement therapy [Odds Ratio (OR) = 1.42, 95% confidence interval (CI) (1.16, 1.73)] and bupropion [OR = 1.52, 95% CI (1.22, 1.89)]. Furthermore, combined interventions were superior to monotherapy in achieving smoking cessation, such as varenicline plus bupropion over bupropion [OR = 2.00, 95% CI (1.11, 3.61)], varenicline plus nicotine replacement therapy over nicotine replacement therapy [OR = 1.84, 95% CI (1.07, 3.18)], and nicotine replacement therapy plus mecamylamine over naltrexone [OR = 6.29, 95% CI (1.59, 24.90)]. Finally, the surface under the cumulative ranking curve value indicated that nicotine replacement therapy plus mecamylamine had the greatest probability of becoming the best intervention.Conclusion: Most pharmacological interventions demonstrated a benefit in smoking cessation compared with placebo, whether monotherapy or combination therapy. Moreover, confirmed evidence suggested that some combination treatments, such as varenicline plus bupropion and nicotine replacement therapy plus mecamylamine have a higher probability of being the best smoking cessation in

Efficacy and safety of antidepressants for smoking cessation: A systematic review and network meta‐analysis

“…However, Siskind et al showed that varenicline + NRT ranked first in achieving sustained abstinence 32 . Shang et al found that a combination of mecamylamine and nicotine was the best intervention 33 . This difference may have resulted from an emphasis on RCTs reporting on antidepressant treatment in our study, whereas Shang et al's network meta‐analysis evaluated the therapeutic effect of all drug interventions for tobacco, leading to more heterogeneity.…”

Implementation of Specialty Tobacco Use Disorder Services in a Community Health Setting: Support for Enhanced Prescription Practices

“…36 Nicotine replacement therapies in the form of gum, lozenges, and patches, also have established efficacy, particularly when combined with other medications for tobacco treatment. 14,35,37,38 In this community served by safety-net clinics, access to NRT at no cost is critical to ensure that prescriptions are filled and pharmacotherapies are used. Likewise, no cost access to varenicline, which only recently went off patent, is highly beneficial to individuals served by these clinics.…”

“…Overall, utilization of TUD pharmacotherapies has been shown to improve the success rates of smoking cessation, relative to cessation efforts without pharmacotherapy. 10,38 According to the Exploration, Preparation, Implementation, Sustainment Again would be helpful to have the abbreviation here: (EPIS) framework, sustainment is essential for continued meaningful change and public health impact. 26 Results from this project provide initial evidence of sustainment through clinician-level adoption of these evidence-based treatments.…”

“…Despite the recall of varenicline in July 2021, DMH data demonstrate increases in its prescriptions through the remainder of the year, in contrast to nationwide reductions in Chantix prescriptions 36 . Nicotine replacement therapies in the form of gum, lozenges, and patches, also have established efficacy, particularly when combined with other medications for tobacco treatment 14,35,37,38 . In this community served by safety-net clinics, access to NRT at no cost is critical to ensure that prescriptions are filled and pharmacotherapies are used.…”

“…Even when products are available over-the-counter, they can be costly. Overall, utilization of TUD pharmacotherapies has been shown to improve the success rates of smoking cessation, relative to cessation efforts without pharmacotherapy 10,38 …”