The effect of Varenicline and Bupropion on smoking cessation: A network meta-analysis of 20 randomized controlled trials

Guo, Kangle; Wang, Shizhong; Shang, Xue; Fenfen, E; Hou, Liangying; Li, Jieyun; Li, Yanfei; Yang, Kehu; Li, Xiuxia

doi:10.1016/j.addbeh.2022.107329

Cited by 14 publications

(7 citation statements)

References 49 publications

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“…Similarly, Guo et al also showed that the use of varenicline, bupropion, and NRT alone improved smoking cessation rates more than placebo, and the combined intervention was more effective, with varenicline + bupropion showing the best intervention effect. 35 The difference was that our study showed that bupropion + NRT had the highest probability of being the best intervention, possibly due to the heterogeneity of population selection. Guo et al only included general smokers, while our study focused on diseased smokers.…”

Section: Discussionmentioning

confidence: 59%

Efficacy and safety of pharmacological intervention for smoking cessation in smokers with diseases: A systematic review and network meta‐analysis

Xing,

Shang,

Deng

et al. 2023

J Evidence Based Medicine

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ObjectiveTo investigate the most effective and best‐tolerated drugs for treating diseased smokers.MethodsEight databases were searched for randomized controlled trials (RCTs) involving different pharmacological interventions for smoking cessation in disease patients (January 2023). Network meta‐analysis was performed using STATA 15.1 software. The Cochrane Risk of Bias Tool assessed the risk of bias, and confidence in evidence was assessed using CINeMA.ResultsA total of 60 RCTs involving 13,009 patients of 12 disease categories were included. All trials reported 13 interventions, resulting in 78 comparisons. Network meta‐analysis showed that varenicline (OR = 2.30, 95% CI (1.77, 3.00)) and bupropion (OR = 1.65, 95% CI (1.29, 2.11)) showed favorable abstinence effects compared to placebo in the cardiovascular disease population. Nicotine replacement therapy (NRT) had better withdrawal advantages than placebo (OR = 11.18, 95% CI (2.25, 55.54)) in the chronic obstructive pulmonary disease (COPD) population. Some combination treatments showed better results than monotherapy, such as bupropion + NRT was superior to bupropion (OR = 8.45, 95% CI (1.84, 38.89)) and NRT (OR = 4.98, 95% CI (1.25, 19.78)) in mental illness population. The final surface under the cumulative ranking curve indicated that bupropion + NRT achieved the best smoking cessation effect. Overall confidence in the evidence was low. In a comparison of drugs, the results showed that bupropion + NRT had the best safety.ConclusionsMost interventions show the benefit of quitting smoking compared with placebo, including monotherapy and combination therapy. Moreover, varenicline or bupropion combined with NRT is superior to some monotherapies.

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Section: Discussionmentioning

confidence: 59%

Efficacy and safety of pharmacological intervention for smoking cessation in smokers with diseases: A systematic review and network meta‐analysis

Xing,

Shang,

Deng

et al. 2023

J Evidence Based Medicine

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“…Varenicline is considered the standard for tobacco treatment with the highest cessation rates across a wide range of studies. 14,[33][34][35] 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.…”

Section: Discussionmentioning

confidence: 99%

“…Within DMH, trends similarly showed sharper increases among specialty clinics than nonintervention clinics for any NRT and varenicline prescriptions. Varenicline is considered the standard for tobacco treatment with the highest cessation rates across a wide range of studies 14,33–35 . 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 .…”

Section: Discussionmentioning

confidence: 99%

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

Meredith,

Hurley,

Friedman

et al. 2023

J Addict Med

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Objectives Although public efforts to reduce tobacco use have been successful, millions of US adults currently smoke tobacco. Reducing the public health burden of tobacco use disorder (TUD) and eliminating disparities experienced by underresourced communities requires increased accessibility to services. The goal of this study was to assess whether prescriptions for evidence-based medications for tobacco treatment showed steeper growth rates among community health clinics providing specialty TUD services as compared with treatment as usual. Methods Clinic-wide data on prescriptions for smoking cessation pharmacotherapy at 18 primary care or mental health community clinics operated by Los Angeles County were retrieved for 4 years of an ongoing implementation trial. Specialty services included behavioral counseling and medications for tobacco treatment. Descriptive statistics characterized prescriptions rates across clinics and time. Analyses compared the slopes of the changes between intervention groups across time for primary care and mental health sites. Results Within primary care clinics, the most commonly prescribed smoking cessation medications were nicotine patches, nicotine gum, and varenicline. Throughout the trial, all clinics displayed increased rates of prescribing smoking cessation medications. Analytic results supported overall steeper increases in prescription rates for these medications among clinics randomized to specialty services versus treatment as usual within primary care (P = 0.020) and mental health sites (P = 0.004). Conclusions This work provides support for the effectiveness of community-based implementation interventions that promote prescribing smoking cessation medications with the potential to reduce health disparities among communities at greater risk for TUD and its consequences.

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“…In the current study, we found that adding nicotine replacement therapy to Varenicline was not independently effective in smoking cessation success. According to a meta-analysis by Guo et al, in which randomized controlled trials of varenicline therapy were assessed, it was reported that combined treatments with Varenicline, bupropion and nicotine replacement therapy produced more positive results than monotherapies (21). According to the results of another study, it was reported that Varenicline in combination with nicotine replacement was more effective than Varenicline alone in the treatment of tobacco withdrawal (22).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of factors affecting smoking cessation in people treated with Varenicline

Köksal

Sağlam²

2022

Med Sci Discov

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Objective: Aim of the study is to evaluate factors affecting treatment success among individuals receiving varenicline therapy for smoking cessation. Material and Methods: This research was carried out at Istanbul Medeniyet University Göztepe Training and Research Hospital between January 2018 and January 2019. A total of 209 patients in the smoking cessation outpatient clinic who were treated with varenicline Varenicline were constituted into the study group. The Fagerstrom Nicotine Dependence Level Test (FTND) was used to determine individuals' nicotine addiction levels, and the Hospital Anxiety and Depression Scale (HADS) was used to evaluate anxiety and depression levels. Results: There were 90 (43.1%) women and 119 (56.9%) men in the study group and mean age was 41.34 ± 10.93 (21-64) years. Overall, 63.2% (n=132) of varenicline recipients quit smoking. The frequency of quitting smoking due to physician advice was higher in those who quit than those who did not (p=0.011). Multiple logistic regression revealed that the independent factors associated with the lower likelihood of smoking cessation were higher number of cigarettes per day (p=0.008), higher HADS-Total score (p<0.001), post-treatment nervousness (p=0.046), and post-treatment depressive mood (p=0.007), whereas being able to remain smoke-free for longer periods in previous quitting attempts was associated with higher likelihood of success (p=0.005). Conclusion: The success of smoking cessation with varenicline therapy is lower in the presence of the following factors: having high risk for anxiety and depression, smoking a greater number of cigarettes per day, shorter periods of remaining smoke-free in previous quitting attempts, and experiencing nervousness during withdrawal. Receiving physician advice to quit also appears to increase the chance of quitting smoking. Keywords: Smoking; Smoking Cessation; Smoking Cessation Agents; Varenicline; Anxiety; Depression

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The effect of Varenicline and Bupropion on smoking cessation: A network meta-analysis of 20 randomized controlled trials

Cited by 14 publications

References 49 publications

Efficacy and safety of pharmacological intervention for smoking cessation in smokers with diseases: A systematic review and network meta‐analysis

Efficacy and safety of pharmacological intervention for smoking cessation in smokers with diseases: A systematic review and network meta‐analysis

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

Evaluation of factors affecting smoking cessation in people treated with Varenicline

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