Pharmacotherapy for smoking cessation in schizophrenia: a systematic review.
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ABSTRACT:
SUBMITTER: Kozak K
PROVIDER: S-EPMC7183430 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Data regarding the efficacy and safety of smoking-cessation pharmacotherapy after stroke are lacking. We systematically reviewed data on this topic by searching Medline, Cochrane, and Clinicaltrials.gov to identify randomized clinical trials (RCT) and observational studies that assessed the efficacy and safety of nicotine replacement therapy (NRT), varenicline, and bupropion in patients with stroke and TIA. We included studies that reported rates of smoking cessation, worsening or recurrent cerebrovascular disease, seizures, or neuropsychiatric events. We identified 2 RCTs and 6 observational studies; 3 included ischemic stroke and TIA, 2 subarachnoid hemorrhage (SAH), and 3 did not specify. Four studies assessed efficacy; cessation rates ranged from 33% to 66% with pharmacological therapy combined with behavioral interventions versus 15% to 46% without, but no individual study demonstrated a statistically significant benefit. Safety data for varenicline and buopropion in ischemic stroke were scarce. Patients with SAH who received NRT had more seizures (9% vs 2%; P = 0.024) and delirium (19% vs 7%; P = 0.006) in one study, but less frequent vasospasm in 3 studies. In conclusion, combined with behavioral interventions, smoking-cessation therapies resulted in numerically higher cessation rates. Limited safety data may prompt caution regarding seizures and delirium in patients with subarachnoid hemorrhage.
| S-EPMC8908464 | biostudies-literature
Project description:BACKGROUND:In the long term, smoking cessation can decrease the risk of cancer, stroke, and heart attacks and improve overall survival. The aim of the proposed umbrella review is to summarize existing systematic reviews that assessed the effects of pharmacological interventions for smoking cessation and to evaluate the methodological quality of previously conducted systematic reviews. METHODS:Databases such as the Cochrane Library, PubMed, MEDLINE, EMBASE, CINAHIL PsychINFO Web of Science, Conference Papers Index, Scopus, and Google Scholar will be used to retrieve reviews. Systematic reviews which included only randomized control trials will be considered in this review. The primary outcome will be prolonged abstinence from smoking for a minimum of 6 months follow-up, and the secondary outcome will be point abstinence rate from smoking of less than 6 months follow-up but more than 7?days. Methodological quality of the included reviews will be assessed using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool, which contains 16 domains. Two authors will screen the titles and abstracts of all reviews obtained by the search strategy, assess the full text of selected articles for inclusion, and extract data independently. The quality appraisal will be also assessed by two authors (AM, CC) independently, and Cohen's Kappa statistic will be used to assess inter-ratter agreement. The findings of the study will be narrated qualitatively to describe the effect of different pharmacotherapy on smoking cessation. DISCUSSION:The World Health Organization recommends treatment of tobacco dependence as one approach in its comprehensive tobacco control policy. To date, many trials and systematic reviews have been conducted to assess the effectiveness of pharmacotherapy for smoking cessation. Therefore, the findings of the umbrella review will improve clinical decision-making and be used as a baseline for future studies. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42017080906.
| S-EPMC6260841 | biostudies-other
Project description: Not available
| S-EPMC10042551 | biostudies-literature
Project description:Strategies for assisting smoking cessation include behavioural counselling to enhance motivation and to support attempts to quit and pharmacological intervention to reduce nicotine reinforcement and withdrawal from nicotine. Three drugs are currently used as first line pharmacotherapy for smoking cessation, nicotine replacement therapy, bupropion and varenicline. Compared with placebo, the drug effect varies from 2.27 (95% CI 2.02, 2.55) for varenicline, 1.69 (95% CI 1.53, 1.85) for bupropion and 1.60 (95% CI 1.53, 1.68) for any form of nicotine replacement therapy. Despite some controversy regarding the safety of bupropion and varenicline, regulatory agencies consider these drugs as having a favourable benefit/risk profile. However, given the high rate of psychiatric comorbidity in dependent smokers, practitioners should closely monitor patients for neuropsychiatric symptoms. Second-line pharmacotherapies include nortriptyline and clonidine. This review also offers an overview of pipeline developments and issues related to smoking cessation in special populations such as persons with psychiatric comorbidity and pregnant and adolescent smokers.
| S-EPMC4014023 | biostudies-literature
Project description:To assess the efficacy and tolerability of adjunctive pharmacotherapy for smoking cessation in adults with serious mental illness (SMI) by means of a systematic review and network meta-analysis.We searched Embase, Medline, PsychINFO and the Cochrane Central Register of Controlled Trials from database inception to 1 December 2014 for randomized controlled trials (RCTs) published in English. We included all studies of smokers with SMI (including schizophrenia, schizoaffective disorder, bipolar disorder, delusional disorder and depressive psychoses) who were motivated to quit smoking. Pharmacotherapies included nicotine replacement therapy (NRT), bupropion and varenicline delivered as monotherapy or in combination compared with each other or placebo. The efficacy outcome was self-reported sustained smoking cessation, verified biochemically at the longest reported time-point. The tolerability outcome was number of patients discontinuing the trial due to any adverse event.Seventeen study reports were included, which represented 14 individual RCTs. No trials were found in patients with depressive psychoses, delusional disorder or that compared NRT monotherapy with placebo. A total of 356 and 423 participants were included in the efficacy and tolerability analyses, respectively. From the network meta-analysis, both bupropion and varenicline were more effective than placebo [odds ratio (OR) = 4.51, 95% credible interval (CrI) = 1.45-14.04 and OR = 5.17, 95% CrI = 1.78-15.06, respectively]. Data were insensitive to an assessment of varenicline versus bupropion (OR = 1.15, 95% CrI = 0.24-5.45). There were no significant differences in tolerability. All outcomes were rated by GRADE criteria as very low quality.The limited evidence available to date suggests that bupropion and varenicline are effective and tolerable for smoking cessation in adults with serious mental illnesses.
| S-EPMC4801667 | biostudies-literature
Project description:BACKGROUND: Smoking remains the leading preventable cause of premature deaths. Several pharmacological interventions now exist to aid smokers in cessation. These include Nicotine Replacement Therapy [NRT], bupropion, and varenicline. We aimed to assess their relative efficacy in smoking cessation by conducting a systematic review and meta-analysis. METHODS: We searched 10 electronic medical databases (inception to Sept. 2006) and bibliographies of published reviews. We selected randomized controlled trials [RCTs] evaluating interventions for smoking cessation at 1 year, through chemical confirmation. Our primary endpoint was smoking cessation at 1 year. Secondary endpoints included short-term smoking cessation (approximately 3 months) and adverse events. We conducted random-effects meta-analysis and meta-regression. We compared treatment effects across interventions using head-to-head trials and when these did not exist, we calculated indirect comparisons. RESULTS: We identified 70 trials of NRT versus control at 1 year, Odds Ratio [OR] 1.71, 95% Confidence Interval [CI], 1.55-1.88, P =< 0.0001). This was consistent when examining all placebo-controlled trials (49 RCTs, OR 1.78, 95% CI, 1.60-1.99), NRT gum (OR 1.60, 95% CI, 1.37-1.86) or patch (OR 1.63, 95% CI, 1.41-1.89). NRT also reduced smoking at 3 months (OR 1.98, 95% CI, 1.77-2.21). Bupropion trials were superior to controls at 1 year (12 RCTs, OR1.56, 95% CI, 1.10-2.21, P = 0.01) and at 3 months (OR 2.13, 95% CI, 1.72-2.64). Two RCTs evaluated the superiority of bupropion versus NRT at 1 year (OR 1.14, 95% CI, 0.20-6.42). Varenicline was superior to placebo at 1 year (4 RCTs, OR 2.96, 95% CI, 2.12-4.12, P =< 0.0001) and also at approximately 3 months (OR 3.75, 95% CI, 2.65-5.30). Three RCTs evaluated the effectiveness of varenicline versus bupropion at 1 year (OR 1.58, 95% CI, 1.22-2.05) and at approximately 3 months (OR 1.61, 95% CI, 1.16-2.21). Using indirect comparisons, varenicline was superior to NRT when compared to placebo controls (OR 1.66, 95% CI 1.17-2.36, P = 0.004) or to all controls at 1 year (OR 1.73, 95% CI 1.22-2.45, P = 0.001). This was also the case for 3-month data. Adverse events were not systematically different across studies. CONCLUSION: NRT, bupropion and varenicline all provide therapeutic effects in assisting with smoking cessation. Direct and indirect comparisons identify a hierarchy of effectiveness.
| S-EPMC1764891 | biostudies-other
Project description:IntroductionAddressing tobacco use is an important issue in general health care. In order to improve smoking cessation advice, spirometry values can be displayed to the smoker to demonstrate possible lung function impairment. The estimate of so-called lung age may show a decrease in lung function associated with smoking. It has been suggested that performing spirometry on patients who smoke but are asymptomatic can be a useful way to show the adverse effects of smoking. The aim of this systematic review was to determine if providing spirometry results in combination with smoking cessation counselling can increase smoking cessation rates compared to what is achieved through counselling alone.MethodsIn this systematic review, we included randomized controlled trials (RCTs) evaluating smoking cessation interventions for adult smokers. The systematic search was performed in PubMed, Medline, Cochrane Library, Cinahl, Embase, Amed and PsycInfo.ResultsThe literature search resulted in 946 studies, which, after reading by two independent reviewers, were reduced to seven trials that matched the inclusion criteria. Two RCTs showed significant improvement in smoking cessation when giving patients feedback on spirometry results in combination with smoking cessation counselling, compared to patients who received only smoking cessation counselling. In both studies, the spirometry results were expressed as lung age. In the other five studies no difference was found. Five further published study protocols for ongoing RCT studies in the field have been found, and therefore this systematic overview will likely need to be updated within a few years.ConclusionsFew studies have been undertaken to examine the efficacy of spirometry in increasing smoking quit rates. Studies conducted to date have shown mixed results, and there is currently limited evidence in the literature that smoking cessation counselling that includes feedback from spirometry and a demonstration of lung age promotes quit rates.
| S-EPMC6662778 | biostudies-literature
Project description:Tobacco use is the leading cause of preventable disease and death in the USA. However, limited data exists regarding smoking cessation mobile app quality and intervention effectiveness. Innovative and scalable interventions are needed to further alleviate the public health implications of tobacco addiction. The proliferation of the smartphone and the advent of mobile phone health interventions have made treatment more accessible than ever. The purpose of this review was to examine the relation between published scientific literature and available commercial smartphone health apps for smoking cessation to identify the percentage of scientifically supported apps that were commercially available to consumers and to determine how many of the top commercially available apps for smoking cessation were supported by the published scientific literature. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, apps were reviewed in four phases: (1) identified apps from the scientific literature, (2) searched app stores for apps identified in the literature, (3) identified top apps available in leading app stores, and (4) determined which top apps available in stores had scientific support. Seven articles identified six apps with some level of scientific support, three (50%) were available in at least one app store. Conversely, among the top 50 apps suggested by each of the leading app stores, only two (4%) had any scientific support. While half of the scientifically vetted apps remain available to consumers, they are difficult to find among the many apps that are identified through app store searches.
| S-EPMC5526818 | biostudies-literature
Project description:BACKGROUND AND AIMS:Evidence suggests that both the nicotinic receptor ?5 subunit (CHRNA5) and Cytochrome P450 2A6 (CYP2A6) genotypes influence smoking cessation success and response to pharmacotherapy. We examine the effect of CYP2A6 genotype on smoking cessation success and response to cessation pharmacotherapy, and combine these effects with those of CHRNA5 genotypes. DESIGN:Placebo-controlled randomized smoking cessation trial. SETTING:Ambulatory care facility in Wisconsin, USA. PARTICIPANTS:Smokers (n?=?709) of European ancestry were randomized to placebo, bupropion, nicotine replacement therapy or combined bupropion and nicotine replacement therapy. MEASUREMENTS:Survival analysis was used to model time to relapse using nicotine metabolism derived from CYP2A6 genotype-based estimates. Slow metabolism is defined as the lowest quartile of estimated metabolic function. FINDINGS:CYP2A6-defined nicotine metabolic function moderated the effect of smoking cessation pharmacotherapy on smoking relapse over 90 days [hazard ratio (HR)?=?2.81, 95% confidence interval (CI)?=?1.32-5.99, P?=?0.0075], with pharmacotherapy significantly slowing relapse in fast (HR?=?0.39, 95% CI?=?0.28-0.55, P?=?1.97?×?10(-8)), but not slow metabolizers (HR?=?1.09, 95% CI?=?0.55-2.17, P?=?0.80). Further, only the effect of nicotine replacement, and not bupropion, varies with CYP2A6-defined metabolic function. The effect of nicotine replacement on continuous abstinence is moderated by the combined genetic risks from CYP2A6 and CHRNA5 (Wald?=?7.44, d.f.?=?1, P?=?0.0064). CONCLUSIONS:Nicotine replacement therapy is effective among individuals with fast, but not slow, CYP2A6-defined nicotine metabolism. The effect of bupropion on relapse likelihood is unlikely to be affected by nicotine metabolism as estimated from CYP2A6 genotype. The variation in treatment responses among smokers with genes may guide future personalized smoking cessation interventions.
| S-EPMC3946972 | biostudies-literature
Project description:ContextRecent data suggest that the onset of cigarette smoking is now more likely during young adulthood than adolescence. Additionally, the landscape of delivering smoking-cessation interventions has changed in the past decade, with the emergence of mobile phone and web-based approaches. The objective of this study is to update a 2010 systematic review of smoking-cessation interventions for U.S. young adults (aged 18-24 years).Evidence acquisitionElectronic searches were conducted in CINAHL, the Cochrane Library, Embase, PsycINFO, PubMed, Scopus, and Sociological Abstracts to identify eligible interventions from August 31, 2009 through July 17, 2019. Two independent coders critically evaluated the methodology and findings of all retrieved articles. Data analysis was conducted in 2019.Evidence synthesisA total of 17 RCTs and 1 nonrandomized study were added to the original 14 studies meeting the inclusion criteria for this review; these studies varied with respect to sample size, intervention, assessed outcomes, and smoking measures. Of the new studies, 3 increased cessation in the short term, 2 at 6 months, and 1 had short-term effects on cigarette reduction. Pooled analyses supported the use of interventions employing social cognitive theory, quitline counseling, and text message programs for short-term cessation in young adults.ConclusionsOf 32 included studies, 9 demonstrated efficacy of smoking cessation or reduction in U.S. young adults. There were no eligible pharmacologic interventions included in this review. Findings support the promise of 3 approaches for young adult cessation not included in the prior review: text message interventions, sustained quit-and-win contests, and multiple behavior interventions.
| S-EPMC7453837 | biostudies-literature