A Cochrane review [Abstract] 1 included 16 studies with a total of 13 123 subjects with chronic obstructive pulmonary disease (COPD). Nicotine sublingual tablet and varenicline (both high quality evidence), bupropion (moderate quality evidence), and nortriptyline (low quality evidence) increased the quit rate over placebo (table T1). There was high-quality evidence for the effectiveness of pharmacotherapy plus high-intensity behavioural treatment compared with placebo plus high-intensity behavioural treatment (RR 2.53, 95% CI 1.83 to 3.50). Furthermore, high-intensity behavioural treatment increased abstinence rates when compared with usual care (RR 25.38, 95% CI 8.03 to 80.22, moderate quality evidence) or low-intensity behavioural treatment (RR 2.18, 95% CI 1.05 to 4.49). Finally, the results showed effectiveness of various combinations of psychosocial and pharmacological interventions.
| Outcome: Prolonged abstinence at longest follow-up | Relative effect(95% CI) | Assumed risk - Placebo | Corresponding risk - Pharmacological treatment (95% CI) | No of Participants(studies) |
|---|---|---|---|---|
| Alldrug treatment: Follow-up 6 to 12 months (mo) | RR 2.53 (95% CI 1.83, 3.50) | 66 / 1000 | 168 / 1000(136 to 207) | 1429(4) |
| Nicotine replacement therapy: Follow-up: 12 mo | RR 2.60 (95% CI 1.29, 5.24) | 54 / 1000 | 141 / 1000(70 to 283) | 370(1) |
| Varenicline:Follow-up:12 mo | RR 3.34 (95% CI 1.88, 5.92) | 55 / 1000 | 184 / 1000(104 to 326) | 504(1) |
| Bupropion: Follow-up: 6 mo | RR 2.03 (95% CI 1.26, 3.28) | 87 / 1000 | 177 / 1000(110 to 285) | 503(2) |
| Nortriptyline: Follow-up: 6 mo | RR 2.54 (95% CI 0.87, 7.44) | 83 / 1000 | 212 / 1000(72 to 620) | 100(1) |
A systematic review and network meta-analysis 2 included 23 studies involving 13 480 patients. 8 studies were rated as having a high risk of bias, 7 studies had a low risk, and in 8 studies, the risk was unclear. The studies employed 13 different interventions. A combination of behavioral therapy and pharmacotherapy was superior in smoking cessation compared to monotherapy. Varenicline was more helpful for smoking cessation than other single interventions.
Date of latest search: 22 March 2016
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