背景:关于抗尼古丁依赖药物治疗的有效性和安全性,有多个系统评价和荟萃分析。然而,很少有指南来回答治疗吸烟者的临床医生提出的常见问题。因此,本文的目的是促进烟草成瘾的治疗。
方法:12个PICO问题由全球PICO问题制定:“烟草依赖药物治疗的功效和安全性”。进行了系统审查,回答了每个问题,并提出了建议。TheGrade(GradingofRecommendations,评估,开发和评估)系统用于对估计效果的确定性和建议的强度进行评级。
结果:Varenicline,尼古丁替代疗法(NRT),安非他酮和野西汀比安慰剂更有效。伐尼克林和联合尼古丁疗法优于其他疗法。在高度依赖的吸烟者中,建议使用药物组合,那些含有伐尼克林的协会更有效。其他疗效较低的优化策略包括增加剂量,持续时间,或者用varenicline撤退.在特定人群中,建议使用伐尼克兰或NRT。在住院期间,选择的治疗方法是NRT。在怀孕期间,它被指示优先考虑行为治疗。戒烟治疗的资助增加了戒烟者的数量。没有科学证据表明药物治疗青少年戒烟的有效性。
结论:12个问题的答案使我们能够为烟草依赖的药物治疗提供建议和算法。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: The answers to the 12 questions allow us to extract recommendations and algorithms for the pharmacological treatment of tobacco dependence.