Use of varenicline in smokeless tobacco cessation: a systematic review and meta-analysis
A partir d'une revue systématique de la littérature publiée jusqu'en février 2014 (3 études, 744 participants), cette méta-analyse évalue l'efficacité de la varénicline pour arrêter la consommation de tabac sans fumée ainsi que ses effets indésirables
Objective : Conduct a systematic review and meta-analysis on the effectiveness and safety of varenicline in smokeless tobacco cessation.
Methods : PubMed, EMBASE, clinicaltrials.gov and the Cochrane Registry were searched up to February 1, 2014 for randomized clinical trials (RCTs) comparing varenicline to placebo. Random effects Mantel-Haenszel summary relative risks (RR), risk difference (RD) and 95% confidence intervals (CI) were used for analysis and reporting of outcomes. Primary and secondary outcomes were the seven-day point prevalence of smokeless tobacco abstinence at the end of 12 and 26 weeks respectively. Adverse events reported include nausea, sleep disturbance, and mood disorders.
Results : Three published RCTs involving 744 smokeless tobacco users with a mean age of 39.7 years, of which greater than 88% were males, were randomized to varenicline (n = 370) and placebo (n = 374). Subjects in the varenicline arm had a significantly higher seven-day point prevalence of smokeless tobacco abstinence at 12 weeks (48% versus 33%; RR 1.45, 95% CI 1.22 to 1.72, P < 0.0001, I2 = 0%; RD 13%, 95% CI 4 to 23%, P = 0.008) but not at 26 weeks (49% versus 39%; RR 1.38, 95% CI 0.93 to 2.03, P = 0.11, I2 = 51%). There were no statistically significant differences in the incidences of adverse events between the two arms but interpretation is limited by high heterogeneity.
Conclusion : This pooled analysis suggests that varenicline is effective in achieving a seven-day point prevalence of smokeless tobacco abstinence at 12 weeks but showed that this effect was not sustained at 26 weeks.
Nicotine & Tobacco Research , résumé, 2015