Meta-analysis on efficacy of nicotine replacement therapies in smoking cessation

doi:10.1016/S0140-6736(94)90933-4

The Lancet

Volume 343, Issue 8890, 15 January 1994, Pages 139-142

https://doi.org/10.1016/S0140-6736(94)90933-4 Get rights and content

Abstract

Nicotine-replacement therapy (NRT) by gum, transdermal patch, intranasal spray, or inhalation is expensive but how effective is it? We have done a meta-analysis of controlled trials to see how effects on abstinence rates are influenced by the clinical setting, the level of nicotine dependency, the dosage of NRT, and the intensity of additional advice and support offered. Published or unpublished randomised controlled trials of NRT that have assessed abstinence at least 6 months after the start of NRT were identified and 53 trials (42 gum, 9 patch, 1 intranasal spray, 1 inhaler), with data from 17 703 subjects, were included in the analyses. Use of NRT increased the odds ratio (OR) of abstinence to 1·71 (95% confidence interval 1·56-1·87) compared with those allocated to the control interventions. The ORs for the different forms of NRT were 1·61 for gum, 2·07 for transdermal patch, 2 92 for nasal spray, and 3·05 for inhaled nicotine. These odds were non-significantly higher in subjects with higher levels of nicotine dependence but they were largely independent of the intensity of additional support provided or the setting in which NRT was offered. We conclude that the currently available forms of NRT are effective therapies to aid smoking cessation.

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A network meta-analysis (NMA) was conducted to investigate the effect of varenicline (VAR), bupropion (BUP), and nicotine replacement therapy (NRT) on smoking cessation.
Eight databases were searched in May 2021, and only randomized controlled trials (RCTs) using varenicline, bupropion, or NRT (single or combined) for smoking cessation were included. The risk of bias in the included RCTs was assessed using the Cochrane Handbook tool. Stata 15.1 software was used to perform NMA, and the quality of the evidence was evaluated using Confidence in Network Meta-analysis (CINeMA).
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Also, uric acid has been shown to enhance ectopic lipid accumulation in tissues especially following fructose exposure [18]. Nicotine, a major alkaloid of tobacco smoke and predominant chemical among over 4000 compounds in cigarette smoke, is widely used as nicotine replacement therapy (NRT) either as gum or patch preparations for smoking cessation [19]. Nicotine is highly lipid soluble and rapidly crosses the blood-brain barrier and it has been shown to decrease insulin sensitivity following prolonged use of tobacco products or nicotine gum [20,21].
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Current treatments for smoking cessation are not effective for most smokers. This study aims to examine the effectiveness of transcranial Direct Current Stimulation (tDCS) on smoking cessation.
In this randomized, sham-controlled trial study, tobacco-dependent (by DSM-5) male participants were recruited from the general public invitation. Participants were randomly allocated to 5 groups; (A), treatment with 300 mg bupropion for 8 weeks; (B), active tDCS (20 sessions for 4 weeks); (C), sham for group B ; (D), active tDCS (20 sessions for 12 weeks), and (E), sham for group D. The electrode montage was anode F3 and cathode F4. Study outcomes include salivary cotinine, Fagerstrom test for nicotine dependence, and smoked cigarette per day, were examined on three time points. Repeated-measures analysis of variances and the generalized estimation equation (GEE) model were employed for data analysis.
Among 210 volunteers, 170 participants completed the study. Mean age of participants was 42.9 years, ranging from 21 to 64 years. The 6-month point abstinence rates in groups A, B and D were 20%, 7% and 25.7%, and in C, D sham groups were 3.1% and 3% respectively. Results of the GEE model showed that although group D was not different from group A in abstinence rate, i.e., salivary cotinine >4 (p = 0.266), nicotine dependency by Fagerstrom test was lower in this group compared to group A (p = 0.019).
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ArticlesMeta-analysis on efficacy of nicotine replacement therapies in smoking cessation

Abstract

Lancet

Prog Cardiovasc Dis

Addict Behav

Antismoking products

Med J Aust

Drinking coffee and carbonated beverages blocks absorption of nicotine from nicotine polacrilex gum

JAMA

Physical dependence on nicotine in gum

JAMA

Articles
Meta-analysis on efficacy of nicotine replacement therapies in smoking cessation