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Impact Assessment of Repeated Exposure of Organotypic 3D Bronchial and Nasal Tissue Culture Models to Whole Cigarette Smoke
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Combination Therapies for Smoking Cessation: A Hierarchical Bayesian Meta-Analysis
Sarah B Windle1, Kristian B Filion2, Joseph G Mancini1
1Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Quebec, Canada.
American Journal of Preventive Medicine
|September 13, 2016
Summary
Varenicline combined with behavioral therapy (BT) significantly increases smoking cessation abstinence compared to other pharmacotherapy and BT combinations. However, the overall benefit of adding BT to pharmacotherapy remains inconclusive based on current rigorous data.
Area of Science:
- Addiction Medicine
- Clinical Pharmacology
- Behavioral Science
Background:
- Smoking cessation guidelines recommend combination therapies, including behavioral therapy (BT) with pharmacotherapy.
- Previous reviews supporting these guidelines have limitations.
- This study aims to re-evaluate combination therapy efficacy using the most robust available data.
Purpose of the Study:
- To compare the efficacy of smoking cessation combination therapies versus monotherapies.
- To utilize the most rigorous data, specifically randomized controlled trials (RCTs) with biochemically validated abstinence at 12 months.
- To provide an updated evidence-based assessment for treatment guidelines.
Main Methods:
- Systematic review and meta-analysis of RCTs.
- Searched major databases (Cochrane Library, Embase, PsycINFO, PubMed) up to July 2015.
- Employed hierarchical Bayesian models for direct and indirect treatment comparisons.
Main Results:
- Analyzed data from 115 RCTs (57,851 participants).
- Varenicline plus BT showed higher abstinence rates than other pharmacotherapy + BT combinations (e.g., vs. bupropion + BT, OR=1.56).
- Nicotine patch + short-acting NRT demonstrated increased abstinence versus NRT monotherapy (OR=1.63).
Conclusions:
- Combination therapy benefits may be less substantial than previously assumed.
- Varenicline combined with BT is the most effective combination identified for increasing smoking abstinence.
- Further research is needed on other pharmacotherapy combinations, their safety, and tolerability.
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