背景:

在世界范围内，吸烟是可预防的疾病和过早死亡的主要原因。一些药物已经被证明可以帮助人们戒烟，在欧洲和美国有三种被批准用于戒烟的药物:尼古丁替代疗法(NRT)、安非他酮和伐伦克林。在俄罗斯和一些前社会主义经济国家，也许可使用Cytisine(一种与伐伦克林类似的治疗药物)。其他治疗方法，包括去甲triptyline，也经过了有效性测试。

目的:

NRT、安非他酮和伐伦克林与安慰剂相比，在实现长期禁欲(6个月或更长时间)方面如何相互比较?在实现长期禁欲方面，其余的治疗与安慰剂相比如何?不良事件和严重不良事件(SAEs)的风险如何比较两种治疗方法，是否存在弊大于利的情况?

方法:

综述仅限于Cochrane综述，所有综述均包括随机试验。参与者通常是成年吸烟者，但我们排除了针对孕妇、特定疾病组或特定环境的戒烟审查。我们的产品包括尼古丁替代疗法(NRT)、抗抑郁药(安非他酮和去甲三嗪)、尼古丁受体部分激动剂(伐伦克林和半胱氨酸)、抗焦虑药、选择性1型大麻素受体拮抗剂(利莫那班)、氯尼定、洛比林、达尼可林、米卡胺、尼古丁revin、阿片类拮抗剂、尼古丁疫苗和醋酸银。我们的受益结果是，从治疗开始起至少6个月持续或延长的禁欲。我们的危害结果是与每种治疗相关的严重不良事件的发生率。我们在Cochrane图书馆的Cochrane系统评论(CDSR)数据库中搜索任何标题、摘要或关键字字段中含有“吸烟”的评论。最后一次搜索是在2012年11月。我们使用修订版的AMSTAR量表评估方法的质量。对于NRT、安非他酮和安非他酮，我们进行了网络荟萃分析，将两者进行比较，并与安慰剂进行比较，以获得益处，而对严重不良事件风险进行比较的是安非他酮和安非他酮。

主要结果:

我们确定了12项针对治疗的审查。这些分析涵盖了267项研究，涉及101,804名参与者。NRT和安非他酮均优于安慰剂(优势比(OR) 1.84;95%可信区间(CredI)为1.71 ~ 1.99，为1.82;分别为1.60至2.06的95%)。与安慰剂相比，伐伦克林增加了戒烟的几率(或2.88;95%置信2.40到3.47)。丁氨苯丙酮与NRT的头部-头部比较显示疗效相同(OR 0.99;95%置信区间为0.86到1.13)。Varenicline优于单形式NRT(或1.57; 95% CredI 1.29 to 1.91), and to bupropion (OR 1.59; 95% CredI 1.29 to 1.96). Varenicline was more effective than nicotine patch (OR 1.51; 95% CredI 1.22 to 1.87), than nicotine gum (OR 1.72; 95% CredI 1.38 to 2.13), and than 'other' NRT (inhaler, spray, tablets, lozenges; OR 1.42; 95% CredI 1.12 to 1.79), but was not more effective than combination NRT (OR 1.06; 95% CredI 0.75 to 1.48). Combination NRT also outperformed single formulations. The four categories of NRT performed similarly against each other, apart from 'other' NRT, which was marginally more effective than NRT gum (OR 1.21; 95% CredI 1.01 to 1.46). Cytisine (a nicotine receptor partial agonist) returned positive findings (risk ratio (RR) 3.98; 95% CI 2.01 to 7.87), without significant adverse events or SAEs. Across the 82 included and excluded bupropion trials, our estimate of six seizures in the bupropion arms versus none in the placebo arms was lower than the expected rate (1:1000), at about 1:1500. SAE meta-analysis of the bupropion studies demonstrated no excess of neuropsychiatric (RR 0.88; 95% CI 0.31 to 2.50) or cardiovascular events (RR 0.77; 95% CI 0.37 to 1.59). SAE meta-analysis of 14 varenicline trials found no difference between the varenicline and placebo arms (RR 1.06; 95% CI 0.72 to 1.55), and subgroup analyses detected no significant excess of neuropsychiatric events (RR 0.53; 95% CI 0.17 to 1.67), or of cardiac events (RR 1.26; 95% CI 0.62 to 2.56). Nortriptyline increased the chances of quitting (RR 2.03; 95% CI 1.48 to 2.78). Neither nortriptyline nor bupropion were shown to enhance the effect of NRT compared with NRT alone. Clonidine increased the chances of quitting (RR 1.63; 95% CI 1.22 to 2.18), but this was offset by a dose-dependent rise in adverse events. Mecamylamine in combination with NRT may increase the chances of quitting, but the current evidence is inconclusive. Other treatments failed to demonstrate a benefit compared with placebo. Nicotine vaccines are not yet licensed for use as an aid to smoking cessation or relapse prevention. Nicobrevin's UK license is now revoked, and the manufacturers of rimonabant, taranabant and dianicline are no longer supporting the development or testing of these treatments.

作者的结论:

研究表明，NRT、安非他酮、伐伦克林和半胱氨酸可以提高戒烟的几率。联合使用NRT和伐伦克林与辅助戒烟同样有效。去甲triptyline也能提高戒烟的几率。根据目前的证据，没有一种治疗方法出现不良事件，从而减少了它们的使用。进一步研究伐伦克林的安全性和半胱氨酸作为一种有效和可负担的治疗手段的潜力，但不研究NRT的有效性和安全性。