高剂量和联合尼古丁替代治疗、伐尼克兰和安非
2012/12/13
摘要
目的：本研究比较大剂量尼古丁替代治疗（NRT）以及联合NRT治疗与标准剂量NRT贴剂、伐尼克兰和安非他酮对戒断率的影响。
方法：对10个电子数据库进行检索（截止到2012年1月），寻找有关标准剂量（≤ 22 mg）和大剂量（> 22 mg）尼古丁贴剂治疗、联合NRT治疗（如：尼古丁贴剂+尼古丁吸入）、安非他酮和伐尼克兰治疗的戒烟随机对照研究（RCT）。采用随机效应配对荟萃分析和贝叶斯多种治疗比较（MTC）进行分析。
结果：找到146项RCT（65项标准剂量尼古丁贴剂治疗，6项大剂量NRT贴剂治疗；5项大剂量 vs 标准剂量NRT贴剂治疗；5项联合NRT治疗 vs 对照；6项联合治疗 vs 单独NRT贴剂治疗；48项安非他酮治疗和11项伐尼克兰治疗）。MTC分析显示，与对照相比，所有治疗在大部分时间点均具有疗效。与其他干预措施相比，联合NRT治疗和大剂量NRT治疗的疗效优势在不同研究也存在差异。除了伐尼克兰治疗，其他治疗相对于标准剂量NRT治疗的优势不会长期持续。
结论：与不治疗的对照相比，所有药物治疗均能有效促进戒烟。伐尼克兰是唯一疗效优于其他治疗的药物。因此，在开发临床戒烟指南时需考虑上述结果。
（林江涛 审校）
Ann Med. 2012 Aug 6. [Epub ahead of print]
Comparisons of high-dose and combination nicotine replacement therapy, varenicline, and bupropion for smoking cessation: A systematic review and multiple treatment meta-analysis.
Mills EJ, Wu P, Lockhart I, Thorlund K, Puhan M, Ebbert JO.
Source
Department of Clinical Epidemiology & Biostatistics, McMaster University , Hamilton, Ontario , Canada.
Abstract
AIM：This review compared the effect of high-dose nicotine replacement therapy (NRT) and combinations of NRT for increasing smoking abstinence rates compared to standard-dose NRT patch, varenicline, and bupropion on smoking abstinence.
METHODS：Ten electronic databases were searched (up to January 2012) for randomized controlled trials (RCT) of standard-dose (≤ 22 mg) or high-dose nicotine patch therapy (> 22 mg), combination NRT (e.g. nicotine patch + nicotine inhaler), bupropion, and varenicline. Analysis consisted of random-effects pairwise meta-analysis and a Bayesian multiple treatment comparison (MTC).
RESULTS：We identified 146 RCTs (65 standard-doses of the nicotine patch (≤ 22 mg); 6 high-dose NRT patch (> 22 mg); 5 high versus standard-dose NRT patch; 5 combination NRT versus inert controls; 6 combination versus single NRT patch; 48 bupropion; and 11 varenicline). The MTC found that all therapies offered treatment benefits at most time points over controls. Combination NRT and higher-dose NRT did not demonstrate consistent effects over other interventions. With the exception of varenicline, the benefits of treatments over standard-dose NRT were not retained in the long term.
CONCLUSIONS：All pharmacologic treatments were significantly more effective than inert controls. Varenicline was the only treatment demonstrating effects over other options. These results should be considered in the development of clinical practice guidelines.
Ann Med. 2012 Aug 6. [Epub ahead of print]
目的：本研究比较大剂量尼古丁替代治疗（NRT）以及联合NRT治疗与标准剂量NRT贴剂、伐尼克兰和安非他酮对戒断率的影响。
方法：对10个电子数据库进行检索（截止到2012年1月），寻找有关标准剂量（≤ 22 mg）和大剂量（> 22 mg）尼古丁贴剂治疗、联合NRT治疗（如：尼古丁贴剂+尼古丁吸入）、安非他酮和伐尼克兰治疗的戒烟随机对照研究（RCT）。采用随机效应配对荟萃分析和贝叶斯多种治疗比较（MTC）进行分析。
结果：找到146项RCT（65项标准剂量尼古丁贴剂治疗，6项大剂量NRT贴剂治疗；5项大剂量 vs 标准剂量NRT贴剂治疗；5项联合NRT治疗 vs 对照；6项联合治疗 vs 单独NRT贴剂治疗；48项安非他酮治疗和11项伐尼克兰治疗）。MTC分析显示，与对照相比，所有治疗在大部分时间点均具有疗效。与其他干预措施相比，联合NRT治疗和大剂量NRT治疗的疗效优势在不同研究也存在差异。除了伐尼克兰治疗，其他治疗相对于标准剂量NRT治疗的优势不会长期持续。
结论：与不治疗的对照相比，所有药物治疗均能有效促进戒烟。伐尼克兰是唯一疗效优于其他治疗的药物。因此，在开发临床戒烟指南时需考虑上述结果。
（林江涛 审校）
Ann Med. 2012 Aug 6. [Epub ahead of print]
Comparisons of high-dose and combination nicotine replacement therapy, varenicline, and bupropion for smoking cessation: A systematic review and multiple treatment meta-analysis.
Mills EJ, Wu P, Lockhart I, Thorlund K, Puhan M, Ebbert JO.
Source
Department of Clinical Epidemiology & Biostatistics, McMaster University , Hamilton, Ontario , Canada.
Abstract
AIM：This review compared the effect of high-dose nicotine replacement therapy (NRT) and combinations of NRT for increasing smoking abstinence rates compared to standard-dose NRT patch, varenicline, and bupropion on smoking abstinence.
METHODS：Ten electronic databases were searched (up to January 2012) for randomized controlled trials (RCT) of standard-dose (≤ 22 mg) or high-dose nicotine patch therapy (> 22 mg), combination NRT (e.g. nicotine patch + nicotine inhaler), bupropion, and varenicline. Analysis consisted of random-effects pairwise meta-analysis and a Bayesian multiple treatment comparison (MTC).
RESULTS：We identified 146 RCTs (65 standard-doses of the nicotine patch (≤ 22 mg); 6 high-dose NRT patch (> 22 mg); 5 high versus standard-dose NRT patch; 5 combination NRT versus inert controls; 6 combination versus single NRT patch; 48 bupropion; and 11 varenicline). The MTC found that all therapies offered treatment benefits at most time points over controls. Combination NRT and higher-dose NRT did not demonstrate consistent effects over other interventions. With the exception of varenicline, the benefits of treatments over standard-dose NRT were not retained in the long term.
CONCLUSIONS：All pharmacologic treatments were significantly more effective than inert controls. Varenicline was the only treatment demonstrating effects over other options. These results should be considered in the development of clinical practice guidelines.
Ann Med. 2012 Aug 6. [Epub ahead of print]
上一篇：
怀孕的吸烟者使用药物戒烟的疗效和安全性：荟
下一篇：
精神分裂症患者采用伐尼克兰林戒烟：为期12周的
