Peckham Emily, Brabyn Sally, Cook Liz, Tew Garry, Gilbody Simon
Department of Health Sciences, University of York, Heslington, YO10 5DD, UK.
Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.
BMC Psychiatry. 2017 Jul 14;17(1):252. doi: 10.1186/s12888-017-1419-7.
People with severe mental ill health are more likely to smoke than those in the general population. It is therefore important that effective smoking cessation strategies are used to help people with severe mental ill health to stop smoking. This study aims to assess the effectiveness and cost -effectiveness of smoking cessation and reduction strategies in adults with severe mental ill health in both inpatient and outpatient settings.
This is an update of a previous systematic review. Electronic databases were searched during September 2016 for randomised controlled trials comparing smoking cessation interventions to each other, usual care, or placebo. Data was extracted on biochemically-verified, self-reported smoking cessation (primary outcome), as well as on smoking reduction, body weight, psychiatric symptom, and adverse events (secondary outcomes).
We included 26 trials of pharmacological and/or behavioural interventions. Eight trials comparing bupropion to placebo were pooled showing that bupropion improved quit rates significantly in the medium and long term but not the short term (short term RR = 6.42 95% CI 0.82-50.07; medium term RR = 2.93 95% CI 1.61-5.34; long term RR = 3.04 95% CI 1.10-8.42). Five trials comparing varenicline to placebo showed that that the addition of varenicline improved quit rates significantly in the medium term (RR = 4.13 95% CI 1.36-12.53). The results from five trials of specialised smoking cessation programmes were pooled and showed no evidence of benefit in the medium (RR = 1.32 95% CI 0.85-2.06) or long term (RR = 1.33 95% CI 0.85-2.08). There was insufficient data to allowing pooling for all time points for varenicline and trials of specialist smoking cessation programmes. Trials suggest few adverse events although safety data were not always reported. Only one pilot study reported cost effectiveness data.
Bupropion and varenicline, which have been shown to be effective in the general population, also work for people with severe mental ill health and their use in patients with stable psychiatric conditions. Despite good evidence for the effectiveness of smoking cessation interventions for people with severe mental ill health, the percentage of people with severe mental ill health who smoke remains higher than that for the general population.
患有严重精神疾病的人群比普通人群更易吸烟。因此，采用有效的戒烟策略来帮助患有严重精神疾病的人群戒烟非常重要。本研究旨在评估住院和门诊环境下，针对患有严重精神疾病的成年人的戒烟及减少吸烟策略的有效性和成本效益。
这是对之前一项系统评价的更新。于2016年9月检索电子数据库，查找比较戒烟干预措施之间、与常规护理或安慰剂的随机对照试验。提取了经生化验证的自我报告戒烟情况（主要结局）以及减少吸烟量、体重、精神症状和不良事件（次要结局）的数据。
我们纳入了26项药物和/或行为干预试验。汇总了8项比较安非他酮与安慰剂的试验，结果显示安非他酮在中长期可显著提高戒烟率，但短期效果不明显（短期风险比RR = 6.42，95%置信区间CI 0.82 - 50.07；中期RR = 2.93，95% CI 1.61 - 5.34；长期RR = 3.04，95% CI 1.10 - 8.42）。5项比较伐尼克兰与安慰剂的试验表明，添加伐尼克兰在中期可显著提高戒烟率（RR = 4.13，95% CI 1.36 - 12.53）。汇总了5项专门戒烟项目试验的结果，未发现中期（RR = 1.32，95% CI 0.85 - 2.06）或长期（RR = 1.33，95% CI 0.85 - 2.08）有获益证据。对于伐尼克兰以及专门戒烟项目试验，没有足够数据来汇总所有时间点的结果。试验表明不良事件较少，不过并非总是报告了安全性数据。只有一项试点研究报告了成本效益数据。
已证明在普通人群中有效的安非他酮和伐尼克兰，对患有严重精神疾病的人群也有效，可用于病情稳定的精神疾病患者。尽管有充分证据表明戒烟干预措施对患有严重精神疾病的人群有效，但患有严重精神疾病的吸烟者比例仍高于普通人群。
