Efficacy of Varenicline and Nortriptyline in Smoking Cessation: Indirect Comparison of Randomized Controlled TrialsPhiriya Khairod, Saroch Apichartkulchai, Usa Chaikledkaew, Montarat Thavorncharoensap*
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Varenicline is one of the most effective FDA-approved drugs for smoking cessation, but is unavailable or available by prescription only in many countries. On the other hand, nortriptyline, a common antidepressant, can also be used for smoking cessation. To our knowledge, no head-to-head randomised controlled trial comparing the efficacy of varenicline and nortriptyline exists. Thus, the aim of our meta-analysis study is to determine the efficacy of varenicline versus nortriptyline in smoking cessation using indirect comparison method. In our study, randomized controlled trials which compared varenicline or nortriptyline with placebo were included. MEDLINE and the Cochrane Controlled Trials Register were searched from inception to June 2012. Primary outcome was a 7-day-point prevalence of abstinence at week 12, confirmed by end-expiratory carbon monoxide level < 10 ppm and/or urinary cotinine level < 60 ng/ml. Of the 182 articles identified, 13 studies (n = 6,588) were included in the analysis. Results from direct comparison meta-analysis revealed that both varenicline and nortriptyline was significantly more efficacious for smoking cessation than placebo: varenicline (RR = 2.36; 95% CI 1.98 to 2.82), and nortriptyline (RR = 1.86; 95% CI 1.38 to 2.51). On the other hand, result from indirect comparison revealed no statistically significant difference between varenicline and nortriptyline (OR = 1.61; 95% CI 0.82 to 2.91) with regard to a 7-day-point prevalence abstinence at week 12. This study confirmed the benefit and implied the potential use of nortriptyline in smoking cessation. Nevertheless, a head-to-head comparison of nortriptyline and varenicline on long term continuous abstinence rate should be further examined.
Keyword:
indirect comparison, nortriptyline, varenicline, smoking cessation
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