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A meta-analysis of the efficacy of over-the-counter nicotine replacement
Open accessAbstract
OBJECTIVE: To determine whether over-the-counter (OTC) nicotine replacement therapy (NRT) is pharmacologically efficacious, whether it produces abstinence rates similar to those in prescription settings, and to estimate the long term (that is, greater than six month) abstinence rate with OTC NRT. METHOD: Systematic literature review. DATA SOURCES: Medline, Psych Abstracts, bibliographies, requests of scientists. STUDY SELECTION: Studies comparing OTC NRT versus OTC placebo or studies comparing OTC NRT versus prescription NRT that reported abstinence rates and for which a full study report was available. DATA EXTRACTION: Two of the authors independently reviewed studies and compared results. DATA SYNTHESIS: Meta-analysis was performed by first testing for homogeneity across studies, then combining odds ratios (ORs) weighting by inverse variance and proportions weighting by study sample size. RESULTS: One OTC NRT versus OTC placebo nicotine gum study was excluded due to small sample size and different setting. The four remaining studies were randomised trials of nicotine versus placebo patch with ORs of 2.1-3.2. These outcomes were homogenous and when combined resulted in an OR favouring NRT of 2.5 (95% confidence interval (CI) 1.8 to 3.6). Among the two randomised and two non-randomised trials of OTC NRT versus prescription NRT, one small study had an OR of 0.3, two others had ORs of 1.0 and 1.4, and a fourth study had an OR of 3.6. These results were not homogenous; however, when combined via a random effects model the estimated OR was not less than 1.0--that is, OR 1.4 (95% CI 0.6 to 3.3). The long term (that is, greater than six months) quit rates for OTC NRT was 1% and 6% in two studies and 8-11% in five other studies. These results were not homogenous; however, when combined the estimated OR was 7% (95% CI 4% to 11%). CONCLUSIONS: OTC NRT is pharmacologically efficacious and produces modest quit rates similar to that seen in real world prescription practice.
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“Bupropion is thought to target the neurochemistry of nicotine addiction by blocking the reuptake of dopamine and noradrenaline and therefore increasing their levels in the synapse.”
From Tobacco addiction (2008) · cites this paper as [96]
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“It is also considered to function as a noncompetitive nicotinic AChR antagonist (96).”
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Metadata
- Authors
- Hughes, J. R., Shiffman, S., Callas, P., & Zhang, J.
- Affiliations
- University of Vermont (US)
- University of Pittsburgh (US)
- Corresponding author
- Hughes, J R
- ORCID
- Venue
- Tobacco Control
- Publisher
- BMJ
- Published
- 2003-03
- Volume
- 12
- Issue
- 1
- Pages
- 21-27
- ISSN
- 0964-4563 (ISSN-L)
- 1468-3318
- PMC
- PMC1759113
- OpenAlex
- W2135151757
- Cited by
- 203
- References
- 53
- Citations by year
- 2024: 2 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 1 · 2018: 6 · 2017: 7 · 2016: 7 · 2015: 6 · 2014: 8 · 2013: 11 · 2012: 11
- FWCI
- 2.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Tobacco Control (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Pittsburgh
- National Institute on Drug Abuse (DA00490)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Nicotinic Acetylcholine Receptors Study
- Keywords
- nicotine gum, nicotine patch, smoking cessation, abstinence rates, drug efficacy
- MeSH terms
- Smoking Prevention, Nonprescription Drugs, Humans, Nicotine, Drug Prescriptions, Tobacco Use Disorder, Odds Ratio, Smoking Cessation, Treatment Outcome
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