Consultant in Public Health, Tobacco dependence, Amzer Glas , 176 rue de Brest, 35000 Rennes , France +332 99 33 72 67 ;
Expert Opin Pharmacother. 2013 Oct;14(14):1959-67. doi: 10.1517/14656566.2013.818978. Epub 2013 Aug 26.
Tobacco dependence, a chronic relapsing condition, requires repeated interventions and multiple attempts to quit.
Strategies for assisting smoking cessation include behavioural counselling and pharmacotherapy. Three drugs are currently used as first-line pharmacotherapy: nicotine replacement therapy (NRT), bupropion and varenicline. Compared to placebo, the drug effect varies from RR = 2.27 for varenicline, to 1.69 for bupropion, and 1.60 for any form of NRT. Cytisine (similar to varenicline) has a RR = 3.98 compared to placebo (two trials). Second-line pharmacotherapies include nortriptyline and clonidine. This review also offers an overview of pipeline developments.
Effective medications exist, and clinicians should encourage and offer treatment to every smoker. However, most smokers try to quit by themselves, with only about 3% quitting successfully each year. Alternative interventions are needed. Harm reduction has not received much support to date. Safer alternative to tobacco smoking (smoke-free products, long-term use of cessation drugs, or electronic cigarettes) could save lives and reduce the burden of tobacco-related deaths and diseases. Despite some encouragement to develop a research agenda for e-cigarettes, particularly on the safety issues, too little attention has been brought to this area of research.
烟草依赖是一种慢性复发性疾病，需要反复干预和多次尝试戒烟。
帮助戒烟的策略包括行为咨询和药物治疗。目前有三种药物被用作一线药物治疗：尼古丁替代疗法（NRT）、安非他酮和伐尼克兰。与安慰剂相比，药物的效果从 RR = 2.27（用于伐尼克兰）到 RR = 1.69（用于安非他酮），再到 RR = 1.60（用于任何形式的 NRT）不等。烟碱类似物（与伐尼克兰相似）与安慰剂相比，RR = 3.98（两项试验）。二线药物治疗包括去甲替林和可乐定。本综述还概述了药物研发管道的进展。
有效的药物确实存在，临床医生应该鼓励并为每个吸烟者提供治疗。然而，大多数吸烟者都试图自行戒烟，每年只有约 3%的人成功戒烟。需要替代干预措施。到目前为止，减少危害并没有得到太多支持。替代烟草吸烟的更安全方法（无烟雾产品、长期使用戒烟药物或电子烟）可以挽救生命，并减少与烟草相关的死亡和疾病的负担。尽管人们鼓励制定电子烟的研究议程，特别是关于安全问题，但对这一研究领域的关注仍然不足。
