scholarly journals Smoking cessation medicines and e-cigarettes: a systematic review, network meta-analysis and cost-effectiveness analysis

2021 ◽  
Vol 25 (59) ◽  
pp. 1-224
Author(s):  
Kyla H Thomas ◽  
Michael N Dalili ◽  
José A López-López ◽  
Edna Keeney ◽  
David Phillippo ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Cost Effectiveness ◽  
Adverse Events ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Odds Ratio ◽  
Cost Effective ◽  
Credible Interval ◽  
Nicotine Replacement ◽  
The Uk

Background Cigarette smoking is one of the leading causes of early death. Varenicline [Champix (UK), Pfizer Europe MA EEIG, Brussels, Belgium; or Chantix (USA), Pfizer Inc., Mission, KS, USA], bupropion (Zyban; GlaxoSmithKline, Brentford, UK) and nicotine replacement therapy are licensed aids for quitting smoking in the UK. Although not licensed, e-cigarettes may also be used in English smoking cessation services. Concerns have been raised about the safety of these medicines and e-cigarettes. Objectives To determine the clinical effectiveness, safety and cost-effectiveness of smoking cessation medicines and e-cigarettes. Design Systematic reviews, network meta-analyses and cost-effectiveness analysis informed by the network meta-analysis results. Setting Primary care practices, hospitals, clinics, universities, workplaces, nursing or residential homes. Participants Smokers aged ≥ 18 years of all ethnicities using UK-licensed smoking cessation therapies and/or e-cigarettes. Interventions Varenicline, bupropion and nicotine replacement therapy as monotherapies and in combination treatments at standard, low or high dose, combination nicotine replacement therapy and e-cigarette monotherapies. Main outcome measures Effectiveness – continuous or sustained abstinence. Safety – serious adverse events, major adverse cardiovascular events and major adverse neuropsychiatric events. Data sources Ten databases, reference lists of relevant research articles and previous reviews. Searches were performed from inception until 16 March 2017 and updated on 19 February 2019. Review methods Three reviewers screened the search results. Data were extracted and risk of bias was assessed by one reviewer and checked by the other reviewers. Network meta-analyses were conducted for effectiveness and safety outcomes. Cost-effectiveness was evaluated using an amended version of the Benefits of Smoking Cessation on Outcomes model. Results Most monotherapies and combination treatments were more effective than placebo at achieving sustained abstinence. Varenicline standard plus nicotine replacement therapy standard (odds ratio 5.75, 95% credible interval 2.27 to 14.90) was ranked first for sustained abstinence, followed by e-cigarette low (odds ratio 3.22, 95% credible interval 0.97 to 12.60), although these estimates have high uncertainty. We found effect modification for counselling and dependence, with a higher proportion of smokers who received counselling achieving sustained abstinence than those who did not receive counselling, and higher odds of sustained abstinence among participants with higher average dependence scores. We found that bupropion standard increased odds of serious adverse events compared with placebo (odds ratio 1.27, 95% credible interval 1.04 to 1.58). There were no differences between interventions in terms of major adverse cardiovascular events. There was evidence of increased odds of major adverse neuropsychiatric events for smokers randomised to varenicline standard compared with those randomised to bupropion standard (odds ratio 1.43, 95% credible interval 1.02 to 2.09). There was a high level of uncertainty about the most cost-effective intervention, although all were cost-effective compared with nicotine replacement therapy low at the £20,000 per quality-adjusted life-year threshold. E-cigarette low appeared to be most cost-effective in the base case, followed by varenicline standard plus nicotine replacement therapy standard. When the impact of major adverse neuropsychiatric events was excluded, varenicline standard plus nicotine replacement therapy standard was most cost-effective, followed by varenicline low plus nicotine replacement therapy standard. When limited to licensed interventions in the UK, nicotine replacement therapy standard was most cost-effective, followed by varenicline standard. Limitations Comparisons between active interventions were informed almost exclusively by indirect evidence. Findings were imprecise because of the small numbers of adverse events identified. Conclusions Combined therapies of medicines are among the most clinically effective, safe and cost-effective treatment options for smokers. Although the combined therapy of nicotine replacement therapy and varenicline at standard doses was the most effective treatment, this is currently unlicensed for use in the UK. Future work Researchers should examine the use of these treatments alongside counselling and continue investigating the long-term effectiveness and safety of e-cigarettes for smoking cessation compared with active interventions such as nicotine replacement therapy. Study registration This study is registered as PROSPERO CRD42016041302. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 59. See the NIHR Journals Library website for further project information.

scholarly journals Adverse events of smoking cessation treatments (nicotine replacement therapy and non-nicotine prescription medication) and electronic cigarettes in the Food and Drug Administration Adverse Event Reporting System, 2004−2016

2018 ◽  
Vol 6 ◽  
pp. 205031211877795 ◽  
Author(s):  
Yumi Motooka ◽  
Toshinobu Matsui ◽  
Rachel M Slaton ◽  
Ryogo Umetsu ◽  
Akiho Fukuda ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Adverse Event ◽  
Adverse Events ◽  
Confidence Interval ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Odds Ratio ◽  
Electronic Cigarettes ◽  
Reporting Odds Ratio ◽  
Nicotine Replacement

Objectives: Several smoking cessation treatments (nicotine replacement therapy and non-nicotine prescription medication) and electronic cigarettes are widely used. We evaluated the adverse events related to smoking cessation treatments and electronic cigarettes in the US Food and Drug Administration Adverse Event Reporting System database. Methods: We analyzed reports of adverse events associated with smoking cessation treatment and electronic cigarettes terms dated between January 2004 and December 2016. We used the reporting odds ratio with 95% confidence intervals to detect a signal for each adverse event. Results: In total, 8,867,135 reports in the Food and Drug Administration Adverse Event Reporting System database were analyzed. The numbers of adverse events for nicotine replacement therapy (transdermal, buccal, oral, and respiratory administration) were 1673, 1016, 425, and 56, respectively. Nicotine replacement therapy (transdermal, buccal, and oral) demonstrated adverse events of nausea, nicotine dependence, and dizziness. For nicotine (transdermal) exposure, the top 5 adverse events reported were nausea (149 cases, reporting odds ratio: 2.28 (95% confidence interval: 1.92–2.69)), dizziness (132 cases, reporting odds ratio: 3.04 (95% confidence interval: 2.54–3.63)), application site erythema (108 cases, reporting odds ratio: 32.52 (95% confidence interval: 26.74–39.55)), headache (98 cases, reporting odds ratio: 1.84 (95% confidence interval: 1.50–2.25)), and dyspnea (94 cases, reporting odds ratio: 1.93 (95% confidence interval: 1.57–2.38)). Many cases of improper use of nicotine replacement therapies were reported. Nausea, depression, abnormal dreams, insomnia, and other adverse events were reported for varenicline. Insomnia, rash, anxiety, and dizziness were reported for bupropion. We observed electronic cigarettes–related adverse events such as dizziness, dyspnea, nausea, heart rate increased, and tremor. Conclusion: Our findings suggest that an association exists between nicotine-related adverse events and nicotine replacement therapy. Healthcare professionals should closely monitor smokers trying to quit nicotine use for the misuse of nicotine replacement therapy. These findings may be informative to healthcare professionals in order to improve the management of smoking cessation treatment.

Nicotine metabolite ratio and smoking outcomes using nicotine replacement therapy and varenicline among smokers with and without psychiatric illness

2018 ◽  
Vol 32 (9) ◽  
pp. 979-985
Author(s):  
Matthew Clyde ◽  
Andrew Pipe ◽  
Charl Els ◽  
Robert Reid ◽  
Angel Fu ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Odds Ratio ◽  
Supporting Evidence ◽  
Nicotine Replacement ◽  
Psychiatric Status ◽  
Metabolite Ratio ◽  
Psychiatric Conditions ◽  
Nicotine Metabolite Ratio

Introduction: It has been suggested that the effectiveness of nicotine replacement smoking cessation pharmacotherapy may be enhanced by assessing rates of nicotine metabolism using the nicotine metabolite ratio – which reflects differences in the activity of the CYP2A6 hepatic enzyme – and titrating doses appropriately. To date, supporting evidence is equivocal, with little information regarding the assessment and effectiveness of the nicotine metabolite ratio among smokers with psychiatric conditions. Methods: The nicotine metabolite ratio of 499 smokers from the FLEX trial was determined using urine samples obtained at baseline. They were randomized to receive either: standard transdermal nicotine (nicotine replacement therapy); extended nicotine replacement therapy + adjunct nicotine agent; or varenicline. Primary cessation outcomes were seven-day point prevalence at 5, 10, 22, and 52 weeks post-target quit date, comparing across treatment and psychiatric status. Our principal analysis employed logistic regression (outcome: abstinence), using slow metabolizers as the reference category. Results: No differences were observed by nicotine metabolite ratio classification (slow, moderate, fast) with respect to any demographic or smoking-related variables. Nicotine metabolite ratio class did not predict smoking cessation in either the overall sample, or by treatment condition at any time-point (week 52 moderate metabolizers: odds ratio 1.34, 95% confidence interval (0.68–2.63), p=0.394; fast metabolizers: odds ratio 1.04 (0.56–1.91), p=0. 906). Conclusion: Our results did not find any associations between nicotine metabolite ratio and cessation outcomes among smokers using nicotine replacement therapy or varenicline with and without lifetime psychiatric conditions.

Cost Effectiveness of Varenicline in Belgium, Compared with Bupropion, Nicotine Replacement Therapy, Brief Counselling and Unaided Smoking Cessation

2009 ◽  
Vol 29 (10) ◽  
pp. 655-665 ◽  
Author(s):  
Lieven Annemans ◽  
Kristiaan Nackaerts ◽  
Pierre Bartsch ◽  
Jacques Prignot ◽  
Sophie Marbaix
Keyword(s):  
Smoking Cessation ◽  
Cost Effectiveness ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Nicotine Replacement

scholarly journals Assessing the delivery of smoking cessation interventions in adult inpatients

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S311-S311
Author(s):  
Katie Blissard Barnes ◽  
Richard Westmoreland
Keyword(s):  
Smoking Cessation ◽  
Physical Health ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Smoking Status ◽  
Service Users ◽  
Nicotine Replacement ◽  
Adult Inpatient ◽  
The Uk ◽  
Brief Advice

AimsTo assess level of compliance with national and local guidance with regards to the recording of service users smoking status and offering of interventions.BackgroundAcross the general population, prevalence of smoking is decreasing but in those with severe mental illness, the prevalence hasn't significantly changed. LYPFT are working towards becoming a smoke-free trust. The Trust Guidance expects that Trusts should ask 100% of service users if they smoke (which should be recorded on their physical health CQUIN) and of those that do, should be offered nicotine replacement therapy and cessation advice. Public Health England is working towards all hospital trusts across the UK being Smoke-free.MethodAll service users on each of the 4 adult inpatient wards at the Becklin Centre, Leeds, were included in the audit. A total of 78 service users were included in the audit.We reviewed the digital records for every service user, specifically looking at the physical health CQUIN. We recorded if smoking status had been documented and what interventions (if any) had been recorded as given. Possible interventions included offering brief advice and offering Nicotine replacement therapy. We then reviewed medication charts to see if any nicotine replacement therapy had been prescribed.ResultThe audit found that approximately half of all service users in our audit smoked cigarettes and that the vast majority of these had their smoking status documented in their digital medical records.Three quarters of those that smoked were offered brief cessation advice and half of them were offered Nicotine Replacement Therapy. Only a third of service users that smoked had NRT prescribed on their medication chart. This represented 65% of those recorded as being offered NRT.ConclusionThere are numerous possible reasons for the above outcomes. These include a lack of knowledge and confidence in delivering smoking cessation interventions, conversations having taken place but not recorded and confusion regarding the appropriate staff member to deliver the intervention. In addition, whilst only medical professionals typically prescribe NRT, the physical health CQUIN is recorded by nurses. Therefore, this may reflect a lack of communication between staff groups.Our trust will become smoke free in the near future. To facilitate this, we hope to reduce the discrepancy between the number of service users who smoke and the number prescribed NRT.

scholarly journals Practitioners’ Views on Nicotine Replacement Therapy in Pregnancy during Lapse and for Harm Reduction: A Qualitative Study

2019 ◽  
Vol 16 (23) ◽  
pp. 4791
Author(s):  
Ross Thomson ◽  
Lisa McDaid ◽  
Joanne Emery ◽  
Lucy Phillips ◽  
Felix Naughton ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Harm Reduction ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Policy And Practice ◽  
Nicotine Replacement ◽  
Social Ecological ◽  
Pregnant Smokers ◽  
Stop Smoking Services ◽  
The Uk

Many countries, including the UK, recommend nicotine replacement therapy (NRT) for smoking cessation during pregnancy. However, adherence to NRT is generally low, smoking lapse or relapse is common and using NRT to reduce the harm from the number of cigarettes smoked is only advocated in non-pregnant smokers. Two focus groups were conducted with 13 professionals involved in antenatal stop smoking services (SSS). The data were analysed thematically. Two themes were extracted that describe health professionals’ attitudes towards using NRT either during lapses or to reduce smoking in women who cannot quit (harm reduction). These are presented around a social–ecological framework describing three hierarchical levels of influence within smoking cessation support: (1) Organizational: providing NRT during lapses could be expensive for SSS though harm reduction could result in services helping a wider range of clients. (2) Interpersonal: participants felt using NRT for harm reduction was not compatible with cessation-orientated messages practitioners conveyed to clients. (3) Individual: practitioners’ advice regarding using NRT during smoking lapses varied; many were generally uncomfortable about concurrent smoking and NRT use and had strong reservations about recommending NRT when smoking during all but the briefest lapses. Further evidence is required to guide policy and practice.

Is Stress Management Training a Useful Addition to Physician Advice and Nicotine Replacement Therapy during Smoking Cessation in Women? Results of a Randomized Trial

2005 ◽  
Vol 20 (2) ◽  
pp. 127-134 ◽  
Author(s):  
Monika E. Slovinec D'Angelo ◽  
Robert D. Reid ◽  
Stephen Hotz ◽  
Jane Irvine ◽  
Roanne J. Segal ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Confidence Interval ◽  
Stress Management ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Perceived Stress ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Nicotine Replacement ◽  
Quit Smoking

Purpose. To determine whether a stress management (SM) program could improve cessation rates when added to usual care (UC) among women attempting to quit smoking. Design. Randomized controlled trial conducted during a 12-month period. Setting. Smoking cessation clinics located within two tertiary care centers in Ottawa, Ontario. Subjects. A total of 332 women smokers 19 years or older who smoked 10 or more cigarettes per day were recruited via advertisements. Intervention. Either UC (physician advice and nicotine replacement therapy) or UC plus an eight-session group SM training program (coping skills development relevant to smoking-specific and generic stressors). Measures. Point prevalence abstinence 2 and 12 months after study intake. A secondary outcome of interest was change in perceived stress during the intervention period. Results. On an intent-to-treat basis, the addition of SM to UC had no incremental effect on 2-or 12-month abstinence rates. Abstinence rates at 2 months were 26.2% vs. 31.7% in the UC and SM groups, respectively (p = .59). At 12 months, the rates were 18.5% vs. 20.7% (p = .86). When quit rates were compared including only participants who demonstrated adequate adherence to the intervention protocol, there was a significant difference between the UC and SM groups at 2 months (34.9% vs. 48.7%; adjusted odds ratio, 1.88; 95% confidence interval, 1.04–3.42; p = .04) but not at 12 months (23.0% vs. 28.2%; adjusted odds ratio, 1.24; 95% confidence interval, .64–2.41; p = .53). There was a significant reduction in perceived stress from preintervention to postintervention; however, this decrease was not moderated by group assignment. Conclusion. The addition of SM in our setting neither increased abstinence rates nor reduced perceived stress over and above UC in women motivated to quit smoking. Poor attendance at the SM intervention undermined its effectiveness.

Pharmacovigilance Assessment of Cardiac Implications of Nicotine Replacement Therapy Among Smokers

2020 ◽  
Vol 15 (3) ◽  
pp. 173-180
Author(s):  
Oluwafemi Olawuyi ◽  
Kathleen Mathieson
Keyword(s):  
Smoking Cessation ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Odds Ratio ◽  
Adverse Event Reporting System ◽  
Reporting Odds Ratio ◽  
Nicotine Replacement ◽  
Cardiac Disorder ◽  
Study Results ◽  
Disorder Risk

Purpose: The purpose of this quantitative comparative study was to examine the possible relationship between nicotine replacement therapy (NRT) and cardiac disorder risk by comparing the rates of cardiac disorder risk of NRT with cardiac disorder risk of non-replacement drugs among smokers seeking smoking cessation. Methods: The study used retrospective quantitative design, which involved the collection of secondary data from the adverse event reporting system (FAERS) database of the U.S Food and Drug Administration (FDA). Rates of cardiac disorder were compared between the NRT group and non- NRT (varenicline and bupropion) group. Statistical analyses involved using a 2x2 contingency table and logistic regression to calculate odds ratio (reporting odds ratio (ROR)). Results and Discussion: Unadjusted ROR was 0.45 (95% confidence interval [CI] 0.28, 0.70). With age and sex as confounding factors, the smokers in the NRT group still had lower odds of having cardiac disorder risk than the non-NRT group (adjusted ROR=0.44, 95% CI 0.28, 0.70). Conclusion: Our study findings showed lower cardiac disorder risk with the NRT group compared to the non-NRT (varenicline and bupropion) group. While the study did not aim to undermine either using NRT or non-NRT for smoking cessation therapy to prevent smoking illness, the study results offer informed findings that could potentially improve current smoking cessation management using NRT intervention among smokers and enhance smokers’ health outcome. Despite the negative signal detection of cardiac disorder risk with NRT as compared to non-NRT in final findings, we still recommend further research on the causal relationship between NRT and non-NRT and cardiac disorder risk.

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