James Brophy, MD, PhD
Are nicotine receptor partial agonists effective for smoking cessation in adults?
Included studies evaluated selective nicotine receptor partial agonists, including varenicline and cytisine, in adult smokers and had ≥ 6 months follow-up from start of treatment. Outcomes were smoking abstinence at ≥ 6 months and adverse effects.
Cochrane Tobacco Addiction Review Group specialized register, MEDLINE, EMBASE/Excerpta Medica, CINAHL, PsycINFO, and UK and US online trial registries were searched to Sep 2010 for randomized controlled trials (RCTs). 16 RCTS met the selection criteria: 15 evaluated varenicline (n = 10 372), usually in a standard dose (1 mg twice daily), and 1 evaluated cytisine (n = 1214). 12 RCTs (11 for smoking cessation and 1 for relapse prevention) compared varenicline with placebo, and 3 of these RCTs also included a bupropion treatment group (150 mg twice daily); 2 RCTs compared varenicline with the nicotine patch; and 1 RCT compared behavioral supports and gave all patients varenicline. In the varenicline trials, treatment duration was 6 weeks (1 RCT), 12 weeks (13 RCTs), or 52 weeks (1 RCT); follow-up was 24 weeks (4 RCTs) or 52 to 53 weeks (11 RCTs); and all included brief counseling.
Meta-analysis showed that standard-dose varenicline was better than placebo or bupropion for smoking abstinence at ≥ 6 months (Table); standard-dose varenicline and the nicotine patch did not differ (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 risk for nausea (n = 4782, 31% vs 10%, P < 0.001), insomnia (n = 4472, 17% vs 10%, P < 0.001), abnormal dreams (n = 3827, 13% vs 3.9%, P < 0.001), and headache (n = 4155, 14% vs 11%, P = 0.04) more than placebo. Cytisine increased smoking abstinence more than placebo at 2 years (relative benefit increase 61%, 95% CI 24 to 108).
Varenicline is better than placebo or bupropion for smoking abstinence at ≥ 6 months. Evidence is insufficient to determine whether varenicline is better than the nicotine patch.
Varenicline for smoking cessation in adults*
*Abbreviations defined in Glossary. RBI, NNT, and CI calculated from data in article using a fixed-effect model.
†Standard-dose varenicline = 1 mg twice daily.
Brophy J. Review: Varenicline is better than placebo or bupropion, but not clearly different from the nicotine patch, for smoking abstinence. Ann Intern Med. ;154:JC4–4. doi: 10.7326/0003-4819-154-8-201104190-02004
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Published: Ann Intern Med. 2011;154(8):JC4-4.
Cardiology, Coronary Risk Factors, Smoking, Tobacco, Alcohol, and Other Substance Abuse.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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