Sigarayı Bırakmada Vareniklin, Nikotin Replasmanı, Akupunktur. Hangi Yöntem, Ne Kadar Etkili?

Amaç: Sigara bağımlılığının tedavisinde çeşitli yöntemler kullanılmaktadır. Sigara bırakma tedavisi için başvuran ve vareniklin tedavisi, nikotin replasman tedavisi (NRT) ve akupunktur tedavisi alan hastaların sigarayı bırakma durumlarının karşılaştırılması amaçlandı. Yöntemler: Çalışmaya vareniklin tedavisi, NRT ve sigarayı bırakma amaçlı akupunktur tedavisi alan 402 kişi dahil edildi. Bireylerin sosyodemografik verileri, Fagerström nikotin bağımlılık testi sonuçları ve tedavi sonrası 6 ay içerisinde sigarayı bırakmaya ilişkin veriler hasta dosyalarından geriye dönük olarak tarandı. Bulgular: Çalışmaya dahil edilen 402 kişinin %60,4'ü (n=243) vareniklin, %28,1'i (n=113) NRT ve %11,4'ü (n=46) akupunktur tedavisi aldı. Tüm hastaların %63,4’ü (n=255), vareniklin tedavisi alan hastaların %71,2’si (n=173), NRT alan hastaların %56,6’sı (n=64), akupunktur tedavisi gören hastaların %39,1’i (n=18) sigarayı bıraktı. Vareniklin tedavisi gören hastalarda sigarayı bırakma oranının diğer tedavilere göre daha yüksek olduğu (p<0,001), çok yüksek bağımlılıklarda ise vareniklinin diğer tedavilere göre daha etkili olduğu (p<0,001) belirlendi. Sonuç: Vareniklin tedavisi, NRT ve akupunktur tedavisi sigarayı bırakmada etkili yöntemlerdir. Vareniklin tedavisi sigarayı bırakmada diğer tedavilere göre daha etkilidir ve çok yüksek bağımlılık durumlarında bu verim diğer tedavilere göre daha yüksektir.

Varenicline, Nicotine Replacement, Acupuncture for Smoking Cessation. Which Method, How Much Effect?

Aim: Various methods are used in the treatment of cigarette addiction. It was aimed to compare the smoking cessation status of patients who applied for smoking cessation treatment and received varenicline treatment, nicotine replacement therapy (NRT), and acupuncture treatment. Methods: In the study, 402 individuals who received varenicline treatment, NRT, and acupuncture treatment for smoking cessation were included. The sociodemographic data of the individuals, the results of the Fagerström nicotine dependence test, and the data on smoking cessation obtained during the 6 months after the treatment were retrospectively scanned from the patient files. Results: Of the 402 individuals included in the study, 60.4% (n = 243) were treated with varenicline, 28.1% (n = 113) received NRT, and 11.4% (n = 46) were treated with acupuncture. 63.4% (n = 255) of all the patients, 71.2% (n = 173) of the patients treated with varenicline, 56.6% (n = 64) of the patients who received NRT, and 39.1% (n = 18) of the patients treated with acupuncture quit smoking. It was found that smoking cessation rate was higher in the patients treated with varenicline compared to other treatments (p <0.001), and varenicline was more effective than other treatments in very high addiction (p <0.001). Conclusion: Varenicline treatment, NRT, and acupuncture treatment are all effective methods for smoking cessation. Varenicline treatment is more effective in smoking cessation than other treatments, and this efficiency is higher than other treatments in very high addiction.

___

  • Argüder, E., Karalezli, A., Hezer, H., Kiliç, H., Er, M., Hasanoglu, H.C. & Demir, P. (2013) Sigara birakma basarisini etkileyen faktörler. Turk Toraks Dergisi, 14(3), 81. https://doi.org/ 10.5152/ttd.2013.18
  • Aubin, H.-J., Bobak, A., Britton, J.R., Oncken, C., Billing, C.B., Gong, J.,…., & Reeves, K.R. (2008) Varenicline versus transdermal nicotine patch for smoking cessation: results from a randomised open-label trial. Thorax, 63(8), 717-724. https://doi.org/ 10.1136/thx.2007.090647
  • Bier, I.D., Wilson, J., Studt, P. & Shakleton, M. (2002) Auricular acupuncture, education, and smoking cessation: a randomized, sham-controlled trial. American journal of public health, 92(10), 1642-1647. https://doi.org/ 10.2105/AJPH.92.10.1642
  • Cabioglu, M.T., Ergene, N. & Tan, Ü. (2007) Smoking cessation after acupuncture treatment. International Journal of Neuroscience, 117(5), 571-578. https://doi.org/10.080/00207450500535289
  • Cahill, K., Stevens, S., Perera, R. & Lancaster, T. (2013) Pharmacological interventions for smoking cessation: an overview and network meta‐analysis. Cochrane database of systematic reviews (5) (4-46). https://doi.org/10.1002/14651858.CD009329.pub2
  • Chen, D. & Wu, L.-T. (2015) Smoking cessation interventions for adults aged 50 or older: a systematic review and meta-analysis. Drug and alcohol dependence, 154, 14-24. https://doi.org/ 10.1016/j.drugalcdep.2015.06.004
  • Clavel-Chapelon, F., Paoletti, C. & Benhamou, S. (1997) Smoking cessation rates 4 years after treatment by nicotine gum and acupuncture. Preventive medicine, 26(1), 25-28. https://doi.org/ 10.1006/pmed.1996.9997
  • Fiore, M.C., Smith, S.S., Jorenby, D.E. & Baker, T.B. (1994) The effectiveness of the nicotine patch for smoking cessation: a meta-analysis. Jama, 271(24), 1940-1947. https://doi.org/ 10.1001/jama.1994.03510480064036
  • Garrison, G.D. & Dugan, S.E. (2009) Varenicline: a first-line treatment option for smoking cessation. Clin Ther, 31(3), 463-491. https://doi.org/ 10.1016/j.clinthera.2009.03.021
  • Gonzales, D., Rennard, S.I., Nides, M., Oncken, C., Azoulay, S., Billing, C.B., ….., & Reeves, K.R. (2006) Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. Jama, 296(1), 47-55. https://doi.org/ 10.1001/jama.296.1.47
  • Gourlay, S.G., Forbes, A., Marriner, T., Pethica, D. & McNeil, J.J. (1994) Prospective study of factors predicting outcome of transdermal nicotine treatment in smoking cessation. Bmj, 309(6958), 842-846. https://doi.org/ 10.1136/bmj.309.6958.842
  • He, D., Berg, J.E. & Høstmark, A.T. (1997) Effects of acupuncture on smoking cessation or reduction for motivated smokers. Preventive medicine, 26(2), 208-214. https://doi.org/ 10.1006/pmed.1996.0125
  • Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & FAGERSTROM, K. O. (1991). The Fagerström test for nicotine dependence: a revision of the Fagerstrom Tolerance Questionnaire. British journal of addiction, 86(9), 1119-1127. https://doi.org/10.1111/j.1360-0443.1991.tb01879.x
  • Hurt, R.D., Ebbert, J.O., Hays, J.T. & McFadden, D.D. (2009) Treating tobacco dependence in a medical setting. CA: a cancer journal for clinicians, 59(5), 314-326. https://doi.org/ 10.3322/caac.20031
  • Lindson, N., Chepkin, S.C., Ye, W., Fanshawe, T.R., Bullen, C. & Hartmann‐Boyce, J. (2019) Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews (4) (4-124). https://doi.org/ 10.1002/14651858.CD013308
  • Raja, M., Saha, S., Krishna-Reddy, V., Mohd, S., Narang, R. & Sood, P. (2016) Effectiveness of oral health education versus nicotine replacement therapy for tobacco cessation- a parallel randomized clinical trial. J Clin Exp Dent, 8(1), e64-70. https://doi.org/ 10.4317/jced.52738
  • Stead, L.F., Perera, R., Bullen, C., Mant, D., Hartmann‐Boyce, J., Cahill, K. & Lancaster, T. (2012) Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews (11) (3-56). https://doi.org/10.1002/14651858.CD000146.pub4
  • Tahiri, M., Mottillo, S., Joseph, L., Pilote, L. & Eisenberg, M.J. (2012) Alternative smoking cessation aids: a meta-analysis of randomized controlled trials. The American journal of medicine, 125(6), 576-584. https://doi.org/ 10.1016/j.amjmed.2011.09.028
  • Ucar, E.Y., Araz, O., Yilmaz, N., Akgun, M., Meral, M., Kaynar, H. & Saglam, L. (2014) Effectiveness of pharmacologic therapies on smoking cessation success: three years results of a smoking cessation clinic. Multidisciplinary respiratory medicine, 9(1), 1-5. https://doi.org/ 10.1186/2049-6958-9-9
  • Uysal, M.A., Kadakal, F., Karşidağ, C., Bayram, N.G., Uysal, O. & Yilmaz, V. (2004) Fagerstrom test for nicotine dependence: reliability in a Turkish sample and factor analysis. Tuberk Toraks, 52(2), 115-121.
  • Üzer, F. (2018) Devlet hastanesi çalışanlarının sigara kullanma alışkanlıklarına bakış. Türkiye Aile Hekimliği Dergisi, 22(2), 92-99. https://doi.org/ 10.15511/tahd.18.00292
  • Wang, Y.Y., Liu, Z., Wu, Y., Zhang, O., Chen, M., Huang, L.L., …., & Yang, J.S. (2016) Acupuncture for Smoking Cessation in Hong Kong: A Prospective Multicenter Observational Study. Evid Based Complement Alternat Med, 2016, 2865831. https://doi.org/ 10.1155/2016/2865831
  • White, A.R., Rampes, H. & Ernst, E. (2002) Acupuncture for smoking cessation. Cochrane Database of Systematic Reviews (2) (4-20). https://doi.org/ 10.1002/14651858.CD000009
  • Wu, L., Sun, S., He, Y. & Zeng, J. (2015) Effect of smoking reduction therapy on smoking cessation for smokers without an intention to quit: an updated systematic review and meta-analysis of randomized controlled. International journal of environmental research and public health, 12(9), 10235-10253. https://doi.org/ 10.3390/ijerph120910235
  • Wu, T.-P., Chen, F.-P., Liu, J.-Y., Lin, M.-H. & Hwang, S.-J. (2007) A randomized controlled clinical trial of auricular acupuncture in smoking cessation. Journal of the Chinese Medical Association, 70(8), 331-338. https://doi.org/ 10.1016/S1726-4901(08)70014-5
  • Yaşar, Z., Kurt, Ö.K., Talay, F. & Kargı, A. (2014) One-year follow-up results of smoking cessation outpatient clinic: factors affecting the cessation of smoking. Eurasian Journal of Pulmonology, 16(2). https://doi.org/ 10.5152/ejp.2014.48295
  • Zeng, F., Chen, C.I., Mastey, V., Zou, K.H., Harnett, J. & Patel, B.V. (2011) Effects of copayment on initiation of smoking cessation pharmacotherapy: an analysis of varenicline reversed claims. Clin Ther, 33(2), 225-234. https://doi.org/ 10.1016/j.clinthera.2011.02.013