Efficacy of pharmacological intervention for smokeless tobacco cessation in adults: a systematic review and meta-analysis.

BACKGROUND & OBJECTIVES: Smokeless tobacco (SLT) use is a global burden, and its long-term use can result in health issues like oral cancers, oral potentially malignant disorders, etc. This review assessed the effectiveness of behavioural and pharmacological interventions for SLT cessation, adding new dimensions to the evidence found earlier in the literature, including recent trials.

SEARCH METHODS

Four electronic databases were used in the search: PubMed, Scopus, Cochrane, and Web-of-Science. Study Selection included randomized control trials (RCTs) comparing pharmacological and behavioural interventions with or without placebo to help users quit SLT with 3 & 6 months follow-up. Two review writers who separately evaluated abstracts for possible inclusion extracted data from included trials. Mantel-Haenszel's random-effect method was used to assess pooled effects for trial subgroups. Furthermore, the effectiveness of the intervention was evaluated from the reported odds ratios, confidence intervals and quit rates.

RESULTS

Nineteen, consisting of 4575 participants, fulfilled the requirements to be listed in the review. A significant difference was observed at 6 months for pharmacological versus behavioural intervention with a low heterogeneity at a 95% confidence interval. Pooling the fifteen pharmacotherapy-versus-behavioural modification studies in adults, we discovered that pharmacotherapy had a statistically significant impact on raising quit rates by the conclusion of the follow-up period (OR 1.21, 95% CI 1.03 to 1.43; 3271 participants) with low heterogeneity (I = 19%).

CONCLUSION

Worldwide, there has been minimal data on interventions for SLT cessation, yet the pharmacological interventional methods have been found to be comparatively effective than behavioural intervention. Adequate awareness, health care professionals training, and law implementation are necessary to achieve habit cessation.

CLINICAL TRIAL NUMBER

Not Applicable. The present systematic review is registered in PROSPERO's International Prospective Register of Systematic Reviews (registration number CRD42023399178 dated 13th Feb 2023).