A Cochrane review [Abstract] 1 included 5 studies on transdermal nicotine for ulcerative colitis, with a total of 270 participants. A meta-analysis of two trials (n=141), showed a statistically significant benefit for nicotine treatment as compared to placebo. After four to six weeks of treatment 19 of 71 patients treated with transdermal nicotine were in clinical remission compared to 9 of 70 treated with placebo (OR 2.56, 95% CI 1.02 to 6.45). Improvement or remission was noted in 29 of the 71 patients assigned to nicotine compared to 14 of 70 patients assigned to placebo (OR 2.72, 95% CI 1.28 to 5.81). OR for patients with left sided colitis was 2.31 (95% CI 1.05 to 5.10). There was no significant benefit for transdermal nicotine as compared to standard medical therapy: after four to six weeks of oral prednisone or mesalamine, 34 of 63 patients were in clinical or sigmoidoscopic remission compared to 33 of 66 patients treated with transdermal nicotine (OR=0.77, 95% CI 0.37 to 1.60).
A meta-analysis of all five studies demonstrated no statistically significant benefit of nicotine therapy (OR 1.23, 95% CI 0.71 to 2.14). Patients in the transdermal nicotine group were significantly more likely to suffer from an adverse event (OR 3.54, 95% CI 2.07 to 6.08) or to withdrawal due to adverse events (OR 5.82, 95% CI 1.66 to 20.47) than patients treated with placebo or standard medical therapy.
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison).
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