The Effect of Varenicline and Bupropion on Smoking Cessation: A Network Meta-analysis of 20 Randomiz
Thursday, August 18, 2022
Posted by: Natalia Gromov
Guo K, Wang S, Shang X, et al.
The Effect of Varenicline
and Bupropion on Smoking Cessation: A Network Meta-analysis of 20 Randomized
Controlled Trials.
Addict Behav. 2022;131:107329. doi:10.1016/j.addbeh.2022.107329
Objective. A
network meta-analysis (NMA) was conducted to investigate the effect of
varenicline (VAR), bupropion (BUP), and nicotine replacement therapy (NRT) on
smoking cessation.
Methods. Eight
databases were searched in May 2021, and only randomized controlled trials
(RCTs) using varenicline, bupropion, or NRT (single or combined) for smoking
cessation were included. The risk of bias in the included RCTs was assessed
using the Cochrane Handbook tool. Stata 15.1 software was used to perform NMA,
and the quality of the evidence was evaluated using Confidence in Network
Meta-analysis (CINeMA).
Findings. Twenty
RCTs involving 16,702 smokers were included. The risk of bias results showed
that 10 RCTs were rated as high, three were low, and seven were unclear. A
total of 21 pairs were compared based on seven interventions. The NMA showed
that, compared to the placebo (PLA), the other six interventions had
significant efficacy in smoking cessation, where VAR + BUP showed the best
effect of all treatments (odds ratio (OR) = 6.08, 95% confidence interval (CI)
[3.47, 10.66]). Moreover, VAR + BUP was superior to VAR + NRT (OR = 1.66, 95%
CI [1.07, 2.59]) and the three monotherapies (VAR, BUP, and NRT). In the
monotherapies, the results of pairwise comparisons of VAR, BUP, and NRT did not
show significant differences. Finally, the surface under the cumulative ranking
curve (SUCRA) value indicated that VAR + BUP had the greatest probability of
becoming the best intervention.
Conclusions. The
efficacy of VAR, BUP, and NRT alone increased the odds of smoking abstinence
better than the placebo, combined interventions were superior to monotherapy,
and VAR combined with other interventions had a better smoking cessation
effect.
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