Servicio de Neumología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain.
Servicio de Neumología, Hospital Universitario 12 de octubre Madrid, Spain; Universidad Complutense, Madrid, Spain.
Arch Bronconeumol. 2023 Oct;59(10):651-661. doi: 10.1016/j.arbres.2023.07.024. Epub 2023 Jul 28.
There are multiple systematic reviews and meta-analyses on the efficacy and safety of pharmacological treatments against nicotine dependence. However, there are few guidelines to answer frequent questions asked by a clinician treating a smoker. Therefore, the aim of this paper is to facilitate the treatment of tobacco addiction.
12 PICO questions are formulated from a GLOBAL PICO question: "Efficacy and safety of pharmacological treatment of tobacco dependence". A systematic review was carried out to answer each of the questions and recommendations were made. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system was used to grade the certainty of the estimated effects and the strength of the recommendations.
Varenicline, nicotine replacement therapy (NRT), bupropion and cytisine are more effective than placebo. Varenicline and combined nicotine therapy are superior to the other therapies. In smokers with high dependence, a combination of drugs is recommended, being more effective those associations containing varenicline. Other optimization strategies with lower efficacy consist of increasing the doses, the duration, or retreat with varenicline. In specific populations varenicline or NRT is recommended. In hospitalized, the treatment of choice is NRT. In pregnancy it is indicated to prioritize behavioral treatment. The financing of smoking cessation treatments increases the number of smokers who quit smoking. There is no scientific evidence of the efficacy of pharmacological treatment of smoking cessation in adolescents.
The answers to the 12 questions allow us to extract recommendations and algorithms for the pharmacological treatment of tobacco dependence.
有许多关于药物治疗尼古丁依赖的疗效和安全性的系统评价和荟萃分析。然而，针对临床医生在治疗吸烟者时经常提出的问题，很少有指南可以提供答案。因此，本文的目的是为烟草成瘾的治疗提供便利。
从一个 GLOBAL PICO 问题“尼古丁依赖的药物治疗的疗效和安全性”中制定了 12 个 PICO 问题。进行了系统评价，以回答每个问题并提出建议。使用 GRADE（推荐分级、评估、制定与评价）系统对估计效果的确定性和建议的强度进行分级。
伐伦克林、尼古丁替代疗法（NRT）、安非他酮和烟碱类似物（如 cytisine）比安慰剂更有效。伐伦克林和联合尼古丁治疗优于其他疗法。在依赖性高的吸烟者中，建议联合使用药物，含有伐伦克林的联合药物效果更佳。其他效果较低的优化策略包括增加剂量、延长疗程或重新使用伐伦克林。在特定人群中，建议使用伐伦克林或 NRT。在住院患者中，NRT 是首选治疗方法。在妊娠期间，优先选择行为治疗。戒烟治疗的资金投入增加了戒烟者的数量。目前没有科学证据表明药物治疗青少年戒烟的疗效。
这 12 个问题的答案使我们能够提取出治疗烟草依赖的药物治疗建议和算法。
