Du modtager denne e-mail, fordi du abonnerer på servicen Scias Update.
------------------------------
*Dagens forskningsoversigt fra Scias Update:*
Nicotine replacement therapy versus control for smoking cessation.
Cochrane Database Syst Rev. 2018 05 31;5:CD000146
Authors: Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T
Abstract
BACKGROUND: Nicotine replacement therapy (NRT) aims to temporarily 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: To determine the effectiveness and safety of nicotine
replacement therapy (NRT), including gum, transdermal patch, intranasal
spray and inhaled and oral preparations, for achieving long-term smoking
cessation, compared to placebo or 'no NRT' interventions.
SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group trials
register for papers mentioning 'NRT' or any type of nicotine replacement
therapy in the title, abstract or keywords. Date of most recent search is
July 2017.
SELECTION CRITERIA: Randomized trials in people motivated to quit which
compared NRT to placebo or to no treatment. We excluded trials that did not
report cessation rates, and those with follow-up of less than six months,
except for those in pregnancy (where less than six months, these were
excluded from the main analysis). We recorded adverse events from included
and excluded studies that compared NRT with placebo. Studies comparing
different types, durations, and doses of NRT, and studies comparing NRT to
other pharmacotherapies, are covered in separate reviews.
DATA COLLECTION AND ANALYSIS: Screening, data extraction and 'Risk of bias'
assessment followed standard Cochrane methods. 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 136 studies; 133 with 64,640 participants
contributed to the primary comparison between any type of NRT and a placebo
or non-NRT control group. The majority of studies were conducted in adults
and had similar numbers of men and women. People enrolled in the studies
typically smoked at least 15 cigarettes a day at the start of the studies.
We judged the evidence to be of high quality; we judged most studies to be
at high or unclear risk of bias but restricting the analysis to only those
studies at low risk of bias did not significantly alter the result. The RR
of abstinence for any form of NRT relative to control was 1.55 (95%
confidence interval (CI) 1.49 to 1.61). The pooled RRs for each type were
1.49 (95% CI 1.40 to 1.60, 56 trials, 22,581 participants) for nicotine
gum; 1.64 (95% CI 1.53 to 1.75, 51 trials, 25,754 participants) for
nicotine patch; 1.52 (95% CI 1.32 to 1.74, 8 trials, 4439 participants) for
oral tablets/lozenges; 1.90 (95% CI 1.36 to 2.67, 4 trials, 976
participants) for nicotine inhalator; and 2.02 (95% CI 1.49 to 2.73, 4
trials, 887 participants) for nicotine nasal spray. The effects were
largely independent of the definition of abstinence, the intensity of
additional support provided or the setting in which the NRT was offered. A
subset of six trials conducted in pregnant women found a statistically
significant benefit of NRT on abstinence close to the time of delivery (RR
1.32, 95% CI 1.04 to 1.69; 2129 participants); in the four trials that
followed up participants post-partum the result was no longer statistically
significant (RR 1.29, 95% CI 0.90 to 1.86; 1675 participants). Adverse
events from using NRT were related to the type of product, and include skin
irritation from patches and irritation to the inside of the mouth from gum
and tablets. Attempts to quantitatively synthesize the incidence of various
adverse effects were hindered by extensive variation in reporting the
nature, timing and duration of symptoms. The odds ratio (OR) of chest pains
or palpitations for any form of NRT relative to control was 1.88 (95% CI
1.37 to 2.57, 15 included and excluded trials, 11,074 participants).
However, chest pains and palpitations were rare in both groups and serious
adverse events were extremely rare.
AUTHORS' CONCLUSIONS: There is high-quality evidence that all of the
licensed forms of NRT (gum, transdermal patch, nasal spray, inhalator 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% to 60%, regardless of setting, and further research
is very unlikely to change our confidence in the estimate of the effect.
The relative 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. NRT often
causes minor irritation of the site through which it is administered, and
in rare cases can cause non-ischaemic chest pain and palpitations.
PMID: 29852054
------------------------------
Dette abstract er hentet via PubMed fra National Library of Medicine, USA
<https://www.ncbi.nlm.nih.gov/home/about/policies>.
------------------------------
Læs mere om folkesundhedsvidenskabelige forskningsoversigter, adgang til
artikler, kvalitetsvurdering og folkenene bag Scias Update på
scias.dk/update.
Du kan også finde ovenstående abstract på *Facebook*
<https://evidens.link/2uCTDbo> eller *PubMed* <https://fsv.link/2LcYydi>.
------------------------------
Hvis du ikke længere ønsker at modtage disse opdateringer om nye opslag fra
Scias Update, skal du gå ind på update.scias.dk/e-mail.
Samme sted kan du vælge at modtage en ugentlig e-mail, hvis du ikke ønsker
at modtage en ny oversigt på alle hverdage.
Mange hilsner
Scias Update (scias.dk/update)
