Efficacy of pharmacotherapies for short-term smoking abstinance: a systematic review and meta-analysis

Abstract

Background: Smoking cessation has important immediate health benefits. The comparative short-term effectiveness of smoking cessation interventions is not well known. We aimed to determine the relative effectiveness of nicotine replacement therapy (NRT), bupropion and varenicline at 4 weeks post-target quit date.

Methods: We searched 10 electronic medical databases (inception to October 2008). We selected randomized clinical trials [RCTs] evaluating interventions for our primary outcome of abstinence from smoking at at-least 4 weeks post-target quit date, with biochemical confirmation. We conducted random-effects odds ratio (OR) meta-analysis and meta-regression. We compared treatment effects across interventions using head-to-head trials and calculated indirect comparisons.

Results: We combined a total of 101 trials evaluating delivery of NRT versus inert controls at approximately 4 weeks post-target quit date (total n = 31,321). The pooled overall OR is OR 2.05 (95% Confidence Interval [CI], 1.89-2.23, P =< 0.0001). We pooled data from 31 bupropion trials contributing a total n of 11,118 participants and found a pooled OR of 2.25 (95% CI, 1.94-2.62, P =< 0.0001). We evaluated 9 varenicline trials compared to placebo. Our pooled estimate for cessation at 4 weeks post-target quit date found a pooled OR of 3.16 (95% CI, 2.55-3.91, P =< 0.0001). Two trials evaluated head to head comparisons of varenicline and bupropion and found a pooled estimate of OR 1.86 (95% CI, 1.49-2.33, P =< 0.0001 at 4 weeks post-target quit date. Indirect comparisons were: NRT and bupropion, OR, 1.09, 95% CI, 0.93-1.31, P = 0.28; varenicline and NRT, OR 1.56, 95% CI, 1.23-1.96, P = 0.0002; and, varenicline and bupropion, OR 1.40, 95% CI, 1.08-1.85, P = 0.01.

Conclusion: Pharmacotherapeutic interventions are effective for increasing smoking abstinence rates in the short-term.

Figure 1

Flow diagram of included studies.

Figure 2

Random effects meta-analysis of all NRT trials combined versus all inert controls at 4 weeks. post-TQD.

Figure 3

Funnel plot evaluating publication bias in NRT versus control event rates at 4 weeks post-TQD.

Figure 4

Random effects meta-analysis of smoking cessation with bupropion versus controls at 4-weeks post-TQD.

Figure 5

Random effects meta-analysis of sustained smoking abstinence with bupropion versus controls at 4-weeks post-TQD.

Figure 6

Random effects meta-analysis of varenicline versus placebo at 4 weeks post-TQD.

Figure 7

Indirect comparisons.