用于戒烟的尼古丁替代疗法
2009/07/30
目的：确定与安慰剂相比尼古丁替代疗法帮助戒烟的作用，不同剂型的尼古丁替代疗法（咀嚼片，贴片，喷鼻剂，吸入，药片）在戒烟作用上的不同。明确戒烟作用是否受剂量，剂型，时间，劝告和支持强度，患者是招募的还是接受过治疗的，这些因素的影响。复合的尼古丁替代疗法是否比单一的尼古丁替代疗法更有效.
检索策略：我们搜索烟草成瘾实验协作网为实验的专门登记表，检索标题或摘要或关键词中含’nicotine’ 或 ’NRT’的文章。最晚的检索时间是2007年。
入选标准：NRT对安慰剂组或对未经处理的或不同剂量的NRT之间比较的随机实验，剔除最短随访时间不到6个月和没有报道戒断率的实验。主要的结果测量是从停止开始至少随访6个月。
数据收集和分析：抽取的数据来自研究人数的规模，剂量，尼古丁治疗的形式和延续时间，结果的测量，随机方法相同的研究。主要的结果测量是戒烟从基线开始至少随访6个月。计算每一个研究的RR值。对于每个实验我们要求最严格的戒烟的定义，生物化学验证。Meta-分析用的是混合效应模型。
主要结果：一共132个实验，111个实验中一共有40,000个志愿者这些实验可以进行无论何种形式的NRT和安慰剂或非NRT比较，无论何种形式的NRT的戒烟对对照组的RR值为：1.58 (95% CI: 1.50 - 1.66). 咀嚼片为：1.43 (95% CI: 1.33 -1.53, 53个实验)，贴片为：1.66 (95% CI: 1.53 - 1.81, 41个实验)，吸入剂为：1.90 (95% CI: 1.36 to 2.67, 4个实验)口服的片剂/糖浆为：2.00 (95% CI: 1.63 - 2.45, 6个实验) 鼻喷剂为：2.02 (95% CI: 1.49 to 3.73, 4个实验) NRT的疗效独立于治疗的持续时间，额外支持的强度或环境。这一作用与一小组关于非处方NRT研究相似。4 mg的尼古丁咀嚼剂明显优于2 mg的尼古丁咀嚼剂，但更高剂量的获益的证据较弱。有证据表明尼古丁贴剂联合吸收快速的NRT明显优于单一的NRT.只有一个研究直接进行尼古丁和其他的药物治疗比较。在这一研究中，NRT戒烟成功率要低于抗抑郁药安非他酮。
结论：所有市面上可获得的尼古丁替代疗法（咀嚼片，贴片，喷鼻剂，吸入，药片）都能帮助那些试图戒烟的人增加戒掉的机会，尼古丁替代疗法能使成功机会增加50%-70%，无论开始于何种情况，其作用独立于个人的支持强度，虽然更大强度的支持水平对戒烟有利，但对尼古丁替代疗法所取得的成功并非是必不可少的。
（刘超武编译 刘国梁审校）
Cochrane Database Syst Rev. 2008 Jan 23;(1):CD000146
Update of: Cochrane Database Syst Rev. 2004;(3):CD000146
Nicotine replacement therapy for smoking cessation.
Stead LF, Perera R, Bullen C, Mant D, Lancaster T.
University of Oxford, Department of Primary Health Care, Old Road Campus, Headington, Oxford, UK OX3 7LF. lindsay.stead@dphpc.ox.ac.uk
BACKGROUND: The aim of nicotine replacement therapy (NRT) is temporarily to replace much of the nicotine from cigarettes to reduce motivation to smoke and nicotine withdrawal symptoms, thus easing the transition from cigarette smoking to complete abstinence.
OBJECTIVES: The aims of this review were:To determine the effect of NRT compared to placebo in aiding smoking cessation, and to consider whether there is a difference in effect for the different forms of NRT (chewing gum, transdermal patches, nasal spray, inhalers and tablets/lozenges) in achieving abstinence from cigarettes.To determine whether the effect is influenced by the dosage, form and timing of use of NRT; the intensity of additional advice and support offered to the smoker; or the clinical setting in which the smoker is recruited and treated.To determine whether combinations of NRT are more likely to lead to successful quitting than one type alone.To determine whether NRT is more or less likely to lead to successful quitting compared to other pharmacotherapies.
SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register for papers with ’nicotine’ or ’NRT’ in the title, abstract or keywords. Date of most recent search July 2007.
SELECTION CRITERIA: Randomized trials in which NRT was compared to placebo or to no treatment, or where different doses of NRT were compared. We excluded trials which did not report cessation rates, and those with follow up of less than six months. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the type of participants, the dose, duration and form of nicotine therapy, the outcome measures, method of randomization, and completeness of follow up.The main outcome measure was abstinence from smoking after at least six months of follow up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. We calculated the risk ratio (RR) for each study. Where appropriate, we performed meta-analysis using a Mantel-Haenszel fixed-effect model.
MAIN RESULTS: We identified 132 trials; 111 with over 40,000 participants contributed to the primary comparison between any type of NRT and a placebo or non-NRT control group. The RR of abstinence for any form of NRT relative to control was 1.58 (95% confidence interval [CI]: 1.50 to 1.66). The pooled RR for each type were 1.43 (95% CI: 1.33 to 1.53, 53 trials) for nicotine gum; 1.66 (95% CI: 1.53 to 1.81, 41 trials) for nicotine patch; 1.90 (95% CI: 1.36 to 2.67, 4 trials) for nicotine inhaler; 2.00 (95% CI: 1.63 to 2.45, 6 trials) for oral tablets/lozenges; and 2.02 (95% CI: 1.49 to 3.73, 4 trials) for nicotine nasal spray. The effects were largely independent of the duration of therapy, the intensity of additional support provided or the setting in which the NRT was offered. The effect was similar in a small group of studies that aimed to assess use of NRT obtained without a prescription. In highly dependent smokers there was a significant benefit of 4 mg gum compared with 2 mg gum, but weaker evidence of a benefit from higher doses of patch. There was evidence that combining a nicotine patch with a rapid delivery form of NRT was more effective than a single type of NRT. Only one study directly compared NRT to another pharmacotherapy. In this study quit rates with nicotine patch were lower than with the antidepressant bupropion. AUTHORS’
CONCLUSIONS: All of the commercially available forms of NRT (gum, transdermal patch, nasal spray, inhaler and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking. NRTs increase the rate of quitting by 50-70%, regardless of setting.The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual. Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT.
PMID: 18253970 [PubMed - indexed for MEDLINE]
目的：确定与安慰剂相比尼古丁替代疗法帮助戒烟的作用，不同剂型的尼古丁替代疗法（咀嚼片，贴片，喷鼻剂，吸入，药片）在戒烟作用上的不同。明确戒烟作用是否受剂量，剂型，时间，劝告和支持强度，患者是招募的还是接受过治疗的，这些因素的影响。复合的尼古丁替代疗法是否比单一的尼古丁替代疗法更有效.
检索策略：我们搜索烟草成瘾实验协作网为实验的专门登记表，检索标题或摘要或关键词中含’nicotine’ 或 ’NRT’的文章。最晚的检索时间是2007年。
入选标准：NRT对安慰剂组或对未经处理的或不同剂量的NRT之间比较的随机实验，剔除最短随访时间不到6个月和没有报道戒断率的实验。主要的结果测量是从停止开始至少随访6个月。
数据收集和分析：抽取的数据来自研究人数的规模，剂量，尼古丁治疗的形式和延续时间，结果的测量，随机方法相同的研究。主要的结果测量是戒烟从基线开始至少随访6个月。计算每一个研究的RR值。对于每个实验我们要求最严格的戒烟的定义，生物化学验证。Meta-分析用的是混合效应模型。
主要结果：一共132个实验，111个实验中一共有40,000个志愿者这些实验可以进行无论何种形式的NRT和安慰剂或非NRT比较，无论何种形式的NRT的戒烟对对照组的RR值为：1.58 (95% CI: 1.50 - 1.66). 咀嚼片为：1.43 (95% CI: 1.33 -1.53, 53个实验)，贴片为：1.66 (95% CI: 1.53 - 1.81, 41个实验)，吸入剂为：1.90 (95% CI: 1.36 to 2.67, 4个实验)口服的片剂/糖浆为：2.00 (95% CI: 1.63 - 2.45, 6个实验) 鼻喷剂为：2.02 (95% CI: 1.49 to 3.73, 4个实验) NRT的疗效独立于治疗的持续时间，额外支持的强度或环境。这一作用与一小组关于非处方NRT研究相似。4 mg的尼古丁咀嚼剂明显优于2 mg的尼古丁咀嚼剂，但更高剂量的获益的证据较弱。有证据表明尼古丁贴剂联合吸收快速的NRT明显优于单一的NRT.只有一个研究直接进行尼古丁和其他的药物治疗比较。在这一研究中，NRT戒烟成功率要低于抗抑郁药安非他酮。
结论：所有市面上可获得的尼古丁替代疗法（咀嚼片，贴片，喷鼻剂，吸入，药片）都能帮助那些试图戒烟的人增加戒掉的机会，尼古丁替代疗法能使成功机会增加50%-70%，无论开始于何种情况，其作用独立于个人的支持强度，虽然更大强度的支持水平对戒烟有利，但对尼古丁替代疗法所取得的成功并非是必不可少的。
（刘超武编译 刘国梁审校）
Cochrane Database Syst Rev. 2008 Jan 23;(1):CD000146
Update of: Cochrane Database Syst Rev. 2004;(3):CD000146
Nicotine replacement therapy for smoking cessation.
Stead LF, Perera R, Bullen C, Mant D, Lancaster T.
University of Oxford, Department of Primary Health Care, Old Road Campus, Headington, Oxford, UK OX3 7LF. lindsay.stead@dphpc.ox.ac.uk
BACKGROUND: The aim of nicotine replacement therapy (NRT) is temporarily to replace much of the nicotine from cigarettes to reduce motivation to smoke and nicotine withdrawal symptoms, thus easing the transition from cigarette smoking to complete abstinence.
OBJECTIVES: The aims of this review were:To determine the effect of NRT compared to placebo in aiding smoking cessation, and to consider whether there is a difference in effect for the different forms of NRT (chewing gum, transdermal patches, nasal spray, inhalers and tablets/lozenges) in achieving abstinence from cigarettes.To determine whether the effect is influenced by the dosage, form and timing of use of NRT; the intensity of additional advice and support offered to the smoker; or the clinical setting in which the smoker is recruited and treated.To determine whether combinations of NRT are more likely to lead to successful quitting than one type alone.To determine whether NRT is more or less likely to lead to successful quitting compared to other pharmacotherapies.
SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register for papers with ’nicotine’ or ’NRT’ in the title, abstract or keywords. Date of most recent search July 2007.
SELECTION CRITERIA: Randomized trials in which NRT was compared to placebo or to no treatment, or where different doses of NRT were compared. We excluded trials which did not report cessation rates, and those with follow up of less than six months. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the type of participants, the dose, duration and form of nicotine therapy, the outcome measures, method of randomization, and completeness of follow up.The main outcome measure was abstinence from smoking after at least six months of follow up. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. We calculated the risk ratio (RR) for each study. Where appropriate, we performed meta-analysis using a Mantel-Haenszel fixed-effect model.
MAIN RESULTS: We identified 132 trials; 111 with over 40,000 participants contributed to the primary comparison between any type of NRT and a placebo or non-NRT control group. The RR of abstinence for any form of NRT relative to control was 1.58 (95% confidence interval [CI]: 1.50 to 1.66). The pooled RR for each type were 1.43 (95% CI: 1.33 to 1.53, 53 trials) for nicotine gum; 1.66 (95% CI: 1.53 to 1.81, 41 trials) for nicotine patch; 1.90 (95% CI: 1.36 to 2.67, 4 trials) for nicotine inhaler; 2.00 (95% CI: 1.63 to 2.45, 6 trials) for oral tablets/lozenges; and 2.02 (95% CI: 1.49 to 3.73, 4 trials) for nicotine nasal spray. The effects were largely independent of the duration of therapy, the intensity of additional support provided or the setting in which the NRT was offered. The effect was similar in a small group of studies that aimed to assess use of NRT obtained without a prescription. In highly dependent smokers there was a significant benefit of 4 mg gum compared with 2 mg gum, but weaker evidence of a benefit from higher doses of patch. There was evidence that combining a nicotine patch with a rapid delivery form of NRT was more effective than a single type of NRT. Only one study directly compared NRT to another pharmacotherapy. In this study quit rates with nicotine patch were lower than with the antidepressant bupropion. AUTHORS’
CONCLUSIONS: All of the commercially available forms of NRT (gum, transdermal patch, nasal spray, inhaler and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking. NRTs increase the rate of quitting by 50-70%, regardless of setting.The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual. Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT.
PMID: 18253970 [PubMed - indexed for MEDLINE]
