Allan V. Prochazka, MD; Tanner J. Caverly, MD
What are the efficacy and safety of nicotine receptor partial agonists for smoking cessation in adults?
Included studies evaluated selective nicotine receptor partial agonists in adult smokers and had ≥ 6 months of follow-up from start of treatment. Studies of lobeline were excluded. Outcomes included smoking abstinence and serious adverse events (SAEs).
Cochrane Tobacco Addiction Review Group specialized register (which includes searches of MEDLINE, EMBASE/Excerpta Medica, PsycINFO, Web of Science, and Cochrane Central Register of Controlled Trials and hand-searches of specialist journals, conference proceedings, and reference lists of trials and reviews) and US and UK online clinical trial registries were searched in December 2011 for randomized controlled trials (RCTs). Authors of ongoing varenicline and cytosine studies were contacted. 24 RCTs met the selection criteria. Drugs assessed were varenicline (20 RCTs, n = 12 223), cytisine (3 RCTs, n = 2151), and dianicline (1 RCT, n = 602).
Meta-analysis showed that varenicline was better than placebo but did not differ from the nicotine patch for abstinence at ≥ 24 weeks; varenicline was better than bupropion at 52 weeks (Table). Lower-dose varenicline was better than placebo and did not differ from standard-dose varenicline for smoking abstinence at 52 weeks (Table). Varenicline increased SAEs (Table), nausea (n = 6619, 29% vs 9%, P < 0.001), insomnia (n = 6309, 14% vs 9%, P < 0.001), abnormal dreams (n = 5585, 13% vs 4%, P < 0.001), and headache (n = 5913, 13% vs 11%, P = 0.02) more than placebo. Cytisine increased smoking abstinence more than placebo at longest follow-up (2 RCTs, n = 973, relative benefit increase [RBI] 298%, 95% CI 101 to 687); dianicline did not (1 RCT, n = 602, RBI 20%, −18 to 75 at 26 wk).
Varenicline is better than placebo or bupropion and does not differ from the nicotine patch for smoking abstinence. Varenicline increases serious adverse events compared with placebo.
Varenicline for smoking cessation in adults*
*Abbreviations defined in Glossary. RBI, RRI, NNT, NNH, and CI calculated from control event rates, relative risks, and risk differences in article using a fixed-effect model.
†1 mg twice daily.
Allan V. Prochazka, Tanner J. Caverly. Review: Varenicline is better than bupropion but not nicotine patch for smoking abstinence in adults. Ann Intern Med. 2012;157:JC3–7. doi: 10.7326/0003-4819-157-6-201209180-02007
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Published: Ann Intern Med. 2012;157(6):JC3-7.
Cardiology, Coronary Risk Factors, Smoking, Tobacco, Alcohol, and Other Substance Abuse.
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