Transdermal nicotine for induction of remission in ulcerative colitis

McGrath, Jerry; McDonald, JWD; MacDonald, JK

doi:10.1002/14651858.cd004722

Cited by 45 publications

(54 citation statements)

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“…4 Intermittent smokers have often been reported to experience symptomatic exacerbation during periods of nonsmoking and alleviation of symptoms on recommencement of smoking. 2,5,6,15,20 The observation that heavier smokers who quit smoking are more susceptible to the rebound effect of developing UC, compared to lighter smokers, also corroborates the notion of a dose-dependent relationship. 6,9,10,16 Current smokers with UC have been found to have less relapses, 33 require fewer hospitalisations 1,6,24,34,35 and demonstrate a reduced need for oral corticosteroid and immunosuppressant therapy for their disease, compared to ex-smokers and nonsmokers with UC.…”

Section: 21supporting

confidence: 54%

“…Studies conducted to date have investigated the efficacy of nicotine therapy compared to placebo, as well as nicotine therapy compared to oral corticosteroids or mesalazine, in the induction and maintenance of remission in patients with UC. 3,20 Differing routes of administration have been used, including transdermal nicotine patches, nicotine chewing gum and a nicotine-based enema. 3 Nicotine vs. placebo patch.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…McGrath et al 20 included both these RCTs in a metaanalysis and concluded that the use of transdermal nicotine is superior to placebo for induction of remission in patients with UC. Nicotine patch was found to have an OR of 2.56 (95% CI: 1.02-6.45) for induction of remission and an OR of 2.72 (95% CI: 1.28-5.81) for clinical improvement and/or remission.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…Nicotine patch was found to have an OR of 2.56 (95% CI: 1.02-6.45) for induction of remission and an OR of 2.72 (95% CI: 1.28-5.81) for clinical improvement and/or remission. 20 The absolute risk reduction in each case was calculated to be 0.13 (95% CI: 0.01-0.25) and 0.20 (95% CI: 0.06-0.35) respectively. 20 Therefore, the number needed to treat (NNT) with transdermal nicotine patches compared with an equivalent placebo, in addition to the standard therapy of oral mesalazine and corticosteroids, was calculated to be 8 for remission and 5 for clinical improvement.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…20 The absolute risk reduction in each case was calculated to be 0.13 (95% CI: 0.01-0.25) and 0.20 (95% CI: 0.06-0.35) respectively. 20 Therefore, the number needed to treat (NNT) with transdermal nicotine patches compared with an equivalent placebo, in addition to the standard therapy of oral mesalazine and corticosteroids, was calculated to be 8 for remission and 5 for clinical improvement. 20 Thomas et al 79 instead examined transdermal nicotine patches against placebo patches with regard to the maintenance of remission in UC.…”

Section: Clinical Studiesmentioning

confidence: 99%

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Review article: ulcerative colitis, smoking and nicotine therapy

Lunney

Leong

2012

Aliment Pharmacol Ther

121

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SummaryBackgroundSmoking is the best‐characterised environmental association of ulcerative colitis (UC). Smoking has been observed to exert protective effects on both the development and progression of UC.AimsTo examine the association between UC and smoking, possible pathogenic mechanisms and the potential of nicotine as a therapeutic agent in the treatment of UC.MethodsA literature search was conducted through MEDLINE, using the MeSH search terms ‘ulcerative colitis’ and ‘smoking’ or ‘nicotine’. Relevant articles were identified through manual review. The reference lists of these articles were reviewed to include further appropriate articles.ResultsUlcerative colitis is less prevalent in smokers. Current smokers with a prior diagnosis of UC are more likely to exhibit milder disease than ex‐smokers and nonsmokers. There is conflicting evidence for smokers having reduced rates of hospitalisation, colectomy and need for oral corticosteroids and immunosuppressants to manage their disease. Multiple potential active mediators in smoke may be responsible for these clinical effects, including nicotine and carbon monoxide, but the precise mechanism remains unknown. Nicotine has demonstrated variable efficacy in the induction of remission in UC when compared to placebo and conventional medicines. Despite this, the high frequency of adverse events limits its clinical significance.ConclusionsNicotine's application as a therapeutic treatment in ulcerative colitis is limited. Presently, it may be an option considered only in selected cases of acute ulcerative colitis refractory to conventional treatment options. This review also questions whether nicotine is the active component of smoking that modifies risk and inflammation in ulcerative colitis.

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