Liang Chih-Hung, Huang Tsai-Wei, Chiu Wei-Ting, Chung Chen-Chih, Hong Chien-Tai
Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
Cochrane Taiwan, Taipei Medical University, Taipei 11031, Taiwan.
Biomedicines. 2025 Jul 24;13(8):1814. doi: 10.3390/biomedicines13081814.
Epidemiological studies have reported an inverse association between smoking and Parkinson's disease (PD) risk, prompting interest in nicotine as a potential therapeutic agent. The present meta-analysis evaluated the efficacy of nicotine therapy in improving motor symptoms and activities of daily living in patients with PD. PubMed, Embase, and Cochrane Library were systematically searched to identify randomized controlled trials (RCTs) assessing nicotine therapy in PD. Clinical RCTs administering interventions extending beyond 1 week and reporting motor or nonmotor outcomes were included. Random-effects models were used to analyze short-term (<6 months) and long-term (≥6 months) outcomes by using standardized mean differences (SMDs). This meta-analysis included five RCTs (346 participants). Nicotine therapy led to no significant improvement in motor outcomes in the short term (pooled SMD: -0.452, 95% confidence interval: -1.612 to 0.708) or long term (pooled SMD: 0.174, 95% confidence interval: -0.438 to 0.787). Considerable interstudy heterogeneity was noted. Furthermore, short-term nicotine therapy resulted in no significant improvement in daily functioning, cognition, or quality of life. This meta-analysis revealed a lack of compelling evidence suggesting that nicotine-based therapies improve motor or nonmotor outcomes in PD. The findings highlight a disconnect between epidemiological associations and clinical efficacy. Given the prodromal nature of PD pathology and the challenges of early diagnosis, future preventive strategies should be implemented before symptom onset in high-risk individuals identified using advanced biomarker panels.
流行病学研究报告称，吸烟与帕金森病（PD）风险呈负相关，这引发了人们对尼古丁作为一种潜在治疗药物的兴趣。本荟萃分析评估了尼古丁疗法对改善PD患者运动症状和日常生活活动能力的疗效。系统检索了PubMed、Embase和Cochrane图书馆，以确定评估PD患者尼古丁疗法的随机对照试验（RCT）。纳入了干预时间超过1周并报告运动或非运动结果的临床RCT。采用随机效应模型，使用标准化均值差（SMD）分析短期（<6个月）和长期（≥6个月）结果。本荟萃分析纳入了5项RCT（346名参与者）。尼古丁疗法在短期（合并SMD：-0.452，95%置信区间：-1.612至0.708）或长期（合并SMD：0.174，95%置信区间：-0.438至0.787）均未导致运动结果有显著改善。研究间存在相当大的异质性。此外，短期尼古丁疗法在日常功能、认知或生活质量方面也未带来显著改善。本荟萃分析表明，缺乏令人信服的证据表明基于尼古丁的疗法能改善PD患者的运动或非运动结果。研究结果凸显了流行病学关联与临床疗效之间的脱节。鉴于PD病理的前驱性质以及早期诊断的挑战，应在使用先进生物标志物面板识别出的高危个体出现症状之前实施未来的预防策略。
