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The effect of Varenicline and Bupropion on smoking cessation: A network meta-analysis of 20 randomized controlled
Kangle Guo1, Shizhong Wang2, Xue Shang1
1Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China; Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China.
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.
Insights
Varenicline (VAR) and bupropion (BUP) combined showed the highest success rate for smoking cessation compared to placebo and other treatments. Combined therapies, especially with VAR, were more effective than single-drug options.
Area of Science:
- Pharmacology
- Public Health
- Evidence-Based Medicine
Background:
- Smoking remains a leading cause of preventable death worldwide.
- Effective pharmacotherapies are crucial for aiding smoking cessation.
- Varenicline (VAR), bupropion (BUP), and nicotine replacement therapy (NRT) are common smoking cessation aids.
Purpose of the Study:
- To compare the efficacy of VAR, BUP, and NRT in smoking cessation using network meta-analysis (NMA).
- To identify the most effective smoking cessation intervention among available pharmacotherapies.
Main Methods:
- A systematic search of eight databases was conducted in May 2021.
- Included were randomized controlled trials (RCTs) of VAR, BUP, or NRT (single or combined) for smoking cessation.
- Network meta-analysis (NMA) was performed using Stata 15.1, with evidence quality assessed by CINeMA.
Main Results:
- Twenty RCTs involving 16,702 smokers were analyzed.
- Varenicline (VAR) + bupropion (BUP) demonstrated the highest efficacy (OR=6.08, 95% CI [3.47, 10.66]) compared to placebo.
- VAR + BUP was superior to VAR + NRT and monotherapies (VAR, BUP, NRT); monotherapies showed no significant difference from each other.
Conclusions:
- Combined pharmacotherapies are more effective than monotherapy for smoking cessation.
- Varenicline combined with bupropion appears to be the most effective intervention.
- Further research may explore optimal combination strategies for smoking cessation.
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