Background Pharmacotherapies are widely used for smoking cessation.
However, their effect on smoking cessation for people with alcohol
dependence remains unclear. Objective This study aimed to explore the
effects of pharmacotherapies on smoking cessation for people with
alcohol dependence. Methods Five electronic databases were searched in
January 2021 for randomized controlled trials (RCTs) reporting the use
of pharmacotherapies to promote smoking cessation in people with alcohol
dependence. The risk of bias was assessed using the Cochrane tool.
RevMan version 5.3 was used to perform meta-analyses of the changes in
smoking behavior, and the GRADE approach was used to assess the
certainty of the evidence. Results Nine RCTs involving 908 smokers with
alcohol dependence were identified. Eight RCTs were published in the
United States, and one was from Canada. The risk of bias was rated as
low in three studies and unclear in the remaining six. The results of
the meta-analysis showed that, compared with the placebo group,
Varenicline had a significant effect on short-term smoking cessation
(three RCTs, OR = 6.27, 95% CI: [2.49, 15.78], p < 0.05,
very low certainty). Naltrexone had no significant effect on smoking
cessation in short-term or long-term observations (three RCTs, OR =
0.99, 95% CI: [0.54, 1.81], p = 0.97, moderate certainty), and
Topiramate had no significant effect (two RCTs, OR = 1.56, 95% CI:
[0.67, 3.46], p > 0.05, low certainty). Only one trial
reported that Bupropion had no effect on smoking cessation. Conclusion
Varenicline may have a positive effect on smoking cessation in people
with alcohol dependence. However, Naltrexone, Topiramate, and Bupropion
seem to have no clear effect on increasing smoking abstinence among
drinkers. The small number of studies and the low certainty of evidence
indicate that caution is required in interpreting the results.
NALTREXONE, A RELAPSE PREVENTION MAINTENANCE TREATMENT OF ALCOHOL DEPENDENCE: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS