Sevrage tabagique : les stratégies pharmacologiques différentes des traitements standards

Abstract

Three drugs are used as an aid for smoking cessation: nicotine replacement therapy (NRT), varenicline and bupropion. Standard pharmacological strategies have proven their efficacy but may have poor efficacy, especially among "Hard-core smokers" who display low smoking abstinence rates and high relapse rates. Systematic literature review of data on pharmacological strategies for smoking cessation which are different from standard treatments. Sixteen studies were included. Higher dose of nicotine patchs increases smoking abstinence rates. Increasing varenicline dose in smokers who do not respond to the standard dose is associated with high success rates. Extended treatment with nicotine patchs is associated with higher abstinence rate at 6 months but not in the long term. Results of studies on extended treatment with oral NRT are conflicting. Extended treatment with varenicline increases smoking cessation rates. Results of studies on extended treatment with bupropion are conflicting as regards smoking cessation rates. Combination therapy of varenicline with nicotine patchs or with bupropion are more effective than varénicline alone. Varenicline using a flexible quit date have similar efficacy compared with previous fixed quit date studies. Pre-cessation treatment with nicotine patchs or with varenicline increases abstinence rates. There is no difference in smoking cessation effectiveness among bupropion, nicotine replacement therapy and their combination. Similarly, there is no differences in abstinence rates between the active bupropion and nicotine gum and the active bupropion and placebo gum groups. Retreatment with varenicline is efficacious in smokers who have previously taken it. Pharmacological strategies different from standard treatments maybe useful for smoking cessation aid.