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. 2017 Mar 1;19(3):273-281.
doi: 10.1093/ntr/ntw144.

Sex Differences in Smoking Cessation Pharmacotherapy Comparative Efficacy: A Network Meta-analysis

Philip H Smith  1   2   3 , Andrea H Weinberger  4   5 , Ju Zhang  6 , Erin Emme  6 , Carolyn M Mazure  2   3 , Sherry A McKee  2   3
Affiliations

Sex Differences in Smoking Cessation Pharmacotherapy Comparative Efficacy: A Network Meta-analysis

Philip H Smith et al. Nicotine Tob Res. .

Abstract

Introduction: Converging clinical and biological evidence suggest sex is an important factor when selecting a pharmacological intervention for smoking cessation. The current investigation used network meta-analyses to estimate sex differences in the comparative efficacy of transdermal nicotine (TN), varenicline, and sustained release (SR) bupropion for smoking cessation.

Methods: Systematically searched previously published reviews and databases (Medline, PsycINFO, Embase) of randomized, double-blind, placebo-controlled trials of bupropion-SR, TN, and varenicline for cigarette smoking cessation in primary care/general community samples were included.

Results: Thirty-two studies met all criteria and 28 (88%) were included in the final analyses, representing 14 389 smokers (51% female). Results of the full sample (women and men combined) mirrored those from a Cochrane Tobacco Addiction Group network meta-analysis of smoking cessation pharmacotherapy, showing VAR>TN=BUP. All medications improved quit rates over placebo for both women and men. Relative to placebo, varenicline efficacy was similar for women and men. Significant sex differences were evident when comparing varenicline versus TN and varenicline versus bupropion. For women, varenicline was more efficacious than TN (RR = 1.41; 95% CI = 1.12,1.76) and bupropion (RR = 1.38; 95% CI = 1.08,1.77). For men, outcomes for those treated with TN and bupropion were similar to those treated with varenicline. There were no differences in efficacy when comparing bupropion versus TN.

Conclusions: The advantage of varenicline over bupropion SR and TN is greater for women than men. Clinicians should strongly consider varenicline as the first option treatment for women. Among men, the advantage of varenicline over TN or bupropion is less clear.

Implications: This study provides information for the sex-informed treatment of nicotine addiction among cigarette smokers. Relative to placebo, women and men achieved similar outcomes when treated with varenicline; however the advantages of varenicline over transdermal patch and bupropion were greater for women compared to men.

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Figures

Figure 1.
Figure 1.
Flow chart for study inclusion. TN = Transdermal nicotine trials; V = Varenicline trials; B = Bupropion SR trials. Note: Results for different medications overlap for 4 investigations that included multiple treatment arms. This review included a total of 28 investigations of 32 eligible studies, for an overall inclusion rate of 88%.
Figure 2.
Figure 2.
Network analysis head-to-head comparisons for women, men, and both sexes combined.
Figure 3.
Figure 3.
Network meta-analysis placebo comparison effect sizes (95% confidence interval [CI]), with differences in effect size by medication. +p < .10, *p < .05, **p < .01. TN = Transdermal nicotine.
See this image and copyright information in PMC

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