Cese de tabaquismo en personas con enfermedad mental grave: revisión sistemática y metaanálisis en red
Geertruida E Bekkering1,2,3, Johan Detraux4, José A López-López5,6
1Department of Public Health Care and Primary Care, Academic Centre of General Practice, KU Leuven, Leuven, Belgium.
BMJ medicine
|February 19, 2026
Resumen
La vareniclina y el bupropión son eficaces para el cese del tabaquismo a largo plazo en la enfermedad mental grave (EMG). Las terapias combinadas pueden ofrecer beneficios adicionales, aunque los datos sobre eventos adversos graves siguen siendo inciertos.
Área de la Ciencia:
- Psiquiatría
- Salud Pública
- Farmacología
Sus antecedentes:
- Las tasas de tabaquismo son desproporcionadamente altas entre las personas con enfermedad mental grave (EMG).
- Las intervenciones para dejar de fumar son cruciales para mejorar los resultados de salud en esta población.
- La efectividad comparativa de diversas intervenciones en poblaciones con EMG requiere síntesis.
Objetivo del estudio:
- Realizar una revisión sistemática y un metaanálisis en red.
- Evaluar la efectividad y seguridad comparativa de las intervenciones farmacológicas y no farmacológicas para dejar de fumar.
- Evaluar las intervenciones para personas diagnosticadas con esquizofrenia, trastorno bipolar, trastorno depresivo mayor grave o trastorno de estrés postraumático.
Principales métodos:
- Se buscaron en Medline, Embase, Scopus, CENTRAL y Web of Science hasta el 19 de septiembre de 2024.
- Se incluyeron 74 ensayos controlados aleatorizados con 11.023 participantes.
- Se analizaron nueve intervenciones distintas para dejar de fumar.
Principales resultados:
- La vareniclina y el bupropión aumentaron significativamente la abstinencia del tabaquismo a largo plazo en comparación con el placebo o la atención mínima (evidencia de alta y moderada certeza, respectivamente).
- La terapia de reemplazo de nicotina mostró beneficios a corto plazo pero eficacia limitada a largo plazo.
- Las intervenciones combinadas (farmacológicas + no farmacológicas) pueden mejorar la abstinencia a largo plazo (evidencia de baja certeza).
Conclusiones:
- La vareniclina, el bupropión y la terapia de reemplazo de nicotina son probablemente ayudas eficaces para dejar de fumar en personas con EMG.
- Los enfoques combinados pueden proporcionar mayores beneficios, pero la certeza de la evidencia es baja.
- El riesgo de eventos adversos graves en todas las intervenciones sigue siendo muy incierto.
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