Sex Differences in Smoking Cessation Pharmacotherapy Comparative Efficacy: A Network Meta-analysis.
BACKGROUND
Converging clinical and biological evidence suggest sex is an important factor when selecting a pharmacological intervention for smoking cessation. The current investigation used network meta-analyses to estimate sex differences in the comparative efficacy of transdermal nicotine (TN), varenicline, and sustained release (SR) bupropion for smoking cessation.


METHODS
Systematically searched previously published reviews and databases (Medline, PsycINFO, Embase) of randomized, double-blind, placebo-controlled trials of bupropion-SR, TN, and varenicline for cigarette smoking cessation in primary care/general community samples were included.


RESULTS
Thirty-two studies met all criteria and 28 (88%) were included in the final analyses, representing 14 389 smokers (51% female). Results of the full sample (women and men combined) mirrored those from a Cochrane Tobacco Addiction Group network meta-analysis of smoking cessation pharmacotherapy, showing VAR>TN=BUP. All medications improved quit rates over placebo for both women and men. Relative to placebo, varenicline efficacy was similar for women and men. Significant sex differences were evident when comparing varenicline versus TN and varenicline versus bupropion. For women, varenicline was more efficacious than TN (RR = 1.41; 95% CI = 1.12,1.76) and bupropion (RR = 1.38; 95% CI = 1.08,1.77). For men, outcomes for those treated with TN and bupropion were similar to those treated with varenicline. There were no differences in efficacy when comparing bupropion versus TN.


CONCLUSIONS
The advantage of varenicline over bupropion SR and TN is greater for women than men. Clinicians should strongly consider varenicline as the first option treatment for women. Among men, the advantage of varenicline over TN or bupropion is less clear.


CONCLUSIONS
This study provides information for the sex-informed treatment of nicotine addiction among cigarette smokers. Relative to placebo, women and men achieved similar outcomes when treated with varenicline; however the advantages of varenicline over transdermal patch and bupropion were greater for women compared to men.
Community Health and Social Medicine, Sophie Davis School of Biomedical Education/CUNY School of Medicine, New York, NY.|Department of Psychiatry, Yale University School of Medicine, New Haven, CT.|Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT.
Philip H
PH
Smith
Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY.|Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
Andrea H
AH
Weinberger
Department of Biostatistics, Yale University School of Public Health, New Haven, CT.
Ju
J
Zhang
Department of Biostatistics, Yale University School of Public Health, New Haven, CT.
Erin
E
Emme
Department of Psychiatry, Yale University School of Medicine, New Haven, CT.|Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT.
Carolyn M
CM
Mazure
Department of Psychiatry, Yale University School of Medicine, New Haven, CT.|Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT.
Sherry A
SA
McKee
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D009538:Nicotine / Q000627:therapeutic use; D018722:Nicotinic Agonists / Q000627:therapeutic use*; D017678:Sex Distribution; D012907:Smoking / Q000188:drug therapy; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data; D061485:Tobacco Use Cessation Devices; D016896:Treatment Outcome; D000068580:Varenicline / Q000627:therapeutic use
D018722:Nicotinic Agonists; D009538:Nicotine; D000068580:Varenicline