podrían ser percibidas como potenciales conflictos de ...€¦ · • the 28 studies included a...

Relativas a esta presentación existen las siguientes relaciones que podrían ser percibidas como potenciales conflictos de intereses:

Declaración de potenciales conflictos de intereses

podrían ser percibidas como potenciales conflictos de intereses:

Dr. Marcos Garcia Rueda ha colaborado con GSK y Pfizer industrias farmacéuticas con interés en el campo del tratamiento del tabaquismo.

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SPRAY BUCAL DE SPRAY BUCAL DE NICOTINANICOTINA

SPRAY BUCAL DE SPRAY BUCAL DE NICOTINANICOTINA

CHICLE CHICLE 6 6 MGMG

CHICLE 6 MGCHICLE 6 MG

INHALADOR MDIINHALADOR MDI

• Double-blind randomized placebo-controlled, parallel group trialcontrolled, parallel group trial

• n:502

• Primary outcome was prolonged 6 month not smoked on 7 consecutive days, analyzed by intention-to-treat

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• “ Nicotine is a toxic compound that should be

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• “ Nicotine is a toxic compound that should be handled with care, but the frequent warnings of potential fatalities caused by ingestion of small

amounts of tobacco products or diluted nicotine-

containing solutions are unjustified and need to be revised in light of overwhelming data indicating thatmore than 0.5 g of oral nicotine is required to kill anadult. “

“ Short-term nicotine use, such as nicotine

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“ Short-term nicotine use, such as nicotinemedication to aid smoking cessation, appearsto pose little cardiovascular risk, even to

patients with known CVD. “

“ human studies, there appears to be

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“ human studies, there appears to be inadequate evidence for an associationbetween nicotine exposure and the presenceof or lack of a carcinogenic effect due to thelimited information available. In animal studies,

limited evidence suggests an association

between long-term nicotine exposure and a

lack of a complete carcinogenic effect.”

• The inhaled nicotine exposure mediated oxidative-stress induces autophagy-impairment in the

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• The inhaled nicotine exposure mediated oxidative-stress induces autophagy-impairment in themurine lungs as seen by significant (p<0.05, n=4) increase in the expression levels of nitrotyrosineprotein-adduct (oxidative-stress marker, soluble-fraction) and Ub/p62/VCP (impaired-autophagymarker, insoluble-fraction).

“ Overall, our data shows that nicotine, a common component of WPS, e-cigarette vapor and cigarette smoke, induces bronchial epithelial cell apoptosis and senescence via ROS

mediated autophagy-impairment as a potential mechanism for COPD-emphysema

pathogenesis. “

• The 28 studies included a total of 12,758 evaluable subjects, of whom 7,120 received NRT and had two

• A cotinine value that increased by >50% from baseline was recorded at least one

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subjects, of whom 7,120 received NRT and had two cotinine levels measured.

• In the majority of studies, subjects smoked at least 10–15 cigarettes/day at baseline and had smoked for at least 3 years.

• The median increase in cotinine levels among those included in these analyses was >50%–60% (representing levels induced by NRT and any concurrent smoking).

from baseline was recorded at least one visit during treatment in 746 subjects (10.5%); of this group, 69/746 (9.2%) had symptoms.

• Among the total subjects, the incidence of adverse events and high cotinine levels was 69/7,120 (0.97%), and they were mostly categorized as mild or moderate.

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• Providing free nicotinereplacement therapy can be a cost-effective strategy for

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a cost-effective strategy for increasing quit attempts and cessation rates at a population level.

• After controlling for reverse causation, adherence to 10

weeks of cost-free NRT wasassociated with successfulabstinence at six monthspost-treatment.

Population-based proactive tobacco treatment is effective in increasingengagement in evidence-based tobacco cessation treatments and for increasing long-term population quit rates among hard to reach,

socioeconomically disadvantaged smokers.

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• Behavioral and pharmacotherapy interventions

improve rates of smoking cessation among the

general adult population, alone or in combination.

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general adult population, alone or in combination. • Data on the effectiveness and safety of electronic

nicotine delivery systems are limited.

• Interventions that combine pharmacotherapy and

behavioural support increase smoking cessation success

compared to a minimal intervention or usual care.

• Updating this review with an additional 12 studies (5,000 participants) did not materially change the effectestimate.

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estimate.

Authors’ conclusions

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• All of the commercially available forms of NRT (gum, transdermal patch, nasal spray, inhaler and sublingual tablets/lozenges) can help people whomake a quit attempt to increase their chances of successfully stoppingsmoking.

• NRTs increase the rate of quitting by 50 to 70%, regardless of setting. • The effectiveness of NRT appears to be largely independent of the intensity of

additional support provided to the individual. • Provision of more intense levels of support, although beneficial in facilitating

the likelihood of quitting, is not essential to the success of NRT.

“ After more than 100 randomized clinical trials

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“ After more than 100 randomized clinical trialshave been conducted, the overall effectivenessof NRT is in doubt. “

Simple, well-established meta-regressionmethods can test, accommodate, and correctmultiple sources biases, often mentioned butdismissed by conventional systematic reviews.

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Among adults motivated to quit smoking,12 weeks of open-label treatment with nicotine patch, varenicline, or C-NRTproduced no significant differences in biochemically confirmed rates of smoking abstinence at 26 weeks

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• Flexible and combination NRT and varenicline enhance success in the early phases of quitting.

• Varenicline improves abstinence in the medium term; however, there is no clear evidence that either varenicline or flexible, dual-form NRT increase quit rates in the long-term when compared to NRT monotherapy.

“ Snus performed similarly to nicotine gum in cigarette

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“ Snus performed similarly to nicotine gum in cigarette smokers who were interested in completely switching to these products, but was associated with less satisfaction

and greater toxicant exposure than nicotine gum. “

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“E-cigarette use was negatively associated with successful quitting in this large community sample of smokers accessing standard evidence-based smoking cessation treatment through primary care clinics, even after adjusting for covariates such as severity of tobacco dependence, gender, and age. The findings suggest that concurrent use of e-cigarettes with NRT may harm cessation attempts. “

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• Qualitative analyses might be better suited at this stage to determine what is

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• Qualitative analyses might be better suited at this stage to determine what is acceptable to adolescents; patches might be more welcoming with other patch products on the market utilized by this population such as birth control; gum might be limited as students are typically restricted from chewing gum within the school setting.

• Considering these factors and finding a more acceptable method may allow youth to attain the benefits of NRT in a form they will actually use.

• While effectiveness evidence thus far is lacking, methodological improvements are warranted for future trials.

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“ The great demand for NRT and the association between NRT use with quit attempts and abstinence at 1-week posthospitalisationsupports adoption of tobacco treatment in acute psychiatric settings. “

• Randomised placebo-controlled trial of nicotine replacement therapy in pregnancy – clinical effectiveness and safety until 2 years after delivery, with economic evaluation.

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• At 12–24 weeks’ gestation, supplementing behavioural support with a 15 mg per 16 hours nicotine patch was no more effective than placebo in promoting sustained smoking cessation throughout pregnancy.

• Despite significantly higher cessation rates occurring at 1 month in significantly, higher in the NRT group at delivery and this (still non-significant) difference remained at 6, 12 and 24 months.

A postdischarge intervention providing automated telephone calls and free medication resulted in higher rates of smoking cessation at 6 months compared with a standard recommendation to use counseling and medication after discharge.

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• The CLIQ system has favorable cost-effectiveness comparedto other smoking cessation interventions.

• Cost-effectiveness will be greatest for health systems with highnumbers of smokers and with the high smoker participation

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numbers of smokers and with the high smoker participationrates.

• Modelo adecuado y reproducible.• Resultados incontestables.• Rentabilidad desde el 4º año hasta el infinito.

Coste-efectividad

• Distintos escenarios• Resultados por Comunidades Autónomas

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Marcos Garcia Rueda

magarue@gmail.com

unidad.de.tabaquismo@gmail.com