Varenicline for Tobacco-dependent Adults who are not Ready to Discontinue Use: A Systematic Review a
Thursday, January 5, 2023
Posted by: Natalia Gromov
Lopes LC, Zhang Y, Ross S,
et al.
Varenicline for Tobacco-dependent
Adults who are not Ready to Discontinue Use: A Systematic Review and
Meta-analysis.
Ann Am Thorac Soc. 2022;19(12):2077-2086. doi:10.1513/AnnalsATS.202110-1122OC
Rationale. Not
all individuals with tobacco dependence are ready to give up smoking. Research
reveals behavioral differences between adults ready to discontinue tobacco use
and those who are not. Thus, the interventions applied to these populations
might differ. However, the evidence of using varenicline in individuals who are
not ready to discontinue tobacco use is uncertain.
Objectives. To
determine if, in tobacco-dependent adults who report not being ready to
discontinue tobacco use, clinicians should begin treatment with varenicline or
wait until subjects are ready to discontinue tobacco use.
Methods. We
conducted a systematic review to assess the effectiveness and safety of
treatment with varenicline in tobacco-dependent adults who are not ready to
discontinue tobacco use. We systematically searched the Cumulative Index to Nursing
and Allied Health Literature, Embase, MEDLINE, and the Cochrane Central
Register of Controlled Trials to identify randomized controlled trials
comparing varenicline versus placebo for individuals who were not ready to
discontinue tobacco use. Outcomes of interest include point prevalence
abstinence during treatment or at six months or longer, smoking reduction,
motivation to quit, adverse events, and withdrawal symptoms. Two authors
independently extracted data and assessed eligibility and risk of bias using a
standardized data collection form. We followed the Grading of Recommendations,
Assessment, Development and Evaluations approach to assess the certainty of
evidence.
Results. Five
trials met our inclusion criteria. All 2,616 participants were adults who were
not ready to discontinue tobacco use at study entry. For 7-day point prevalence
abstinence at six months or longer, high-certainty evidence suggested that
varenicline increased abstinence compared with placebo (relative risk, 2.00
[95% confidence interval (CI), 1.70-2.35]; absolute risk reduction, 173 more
per 1,000 [95% CI, 121 more to 234 more]). We identified moderate-certainty
evidence suggesting that varenicline increased serious adverse events (relative
risk, 1.75 [95% CI, 0.98-3.13]; absolute risk reduction, 12 more per 1,000 [95%
CI, 0 fewer to 35 more]). For withdrawal, low-certainty evidence suggested that
varenicline treatment was associated with a lower symptom score (mean
difference, 1.54 points lower; 95% CI, 2.15-0.93 points lower; low certainty)
assessed using the Brief Questionnaire of Smoking Urges.
Conclusions. In
tobacco-dependent adults who are not ready to discontinue tobacco use,
initiating varenicline treatment results in a large increase in abstinence and
likely results in a slight increase in serious adverse events.
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