RESUMEN
Objetivo Revisar la eficacia y seguridad de medicamentos para cesación del tabaquismo en el contexto de construcción de guías de práctica clínica (GPC). Métodos Revisión sistemática de GPC para adaptación mediante ADAPTE. Los desenlaces fueron cesación ≥6 meses y seguridad de las intervenciones. Las GPC se calificaron por pares con DELBI. Se extrajeron resultados de estudios agregativos incluidos en las guías seleccionadas. Resultados Los fármacos duplican la cesación comparados con placebo (tasas de 25,0 % hasta 27,0 % al combinarse con consejería). Los mayores incrementos en cesación se obtienen con ansiolíticos y antidepresivos (8,7% a 19,4%), y los menores con terapia de reemplazo nicotínico -TRN- (5,2% a 12,9%). La nortriptilina tiene eficacia similar al bupropion (aproximadamente 10,0 %). Con limitadas excepciones (parche e inhalador, tabletas y bupropion), las combinaciones de medicamentos no incrementan la abstinencia. Conclusiones TRN, vareniclina, bupropion y nortriptilina son eficaces para dejar de fumar. Las combinaciones de medicamentos requieren más evidencia y deberían restringirse a personas con alta dependencia o con falla terapéutica inicial. Serían deseables análisis de costo-efectividad para valorar implementación de programas en países en desarrollo.
Objective To review the efficacy and safety of pharmacotherapy for smoking cessation in the context of clinical practice guidelines (CPG). Methods A systematic review of CPGs was conducted, aimed at adapting recommendations for Colombia following the ADAPTE methodology. Outcomes comprised 6-months or higher smoking cessation rates and intervention safety. CPGs were peer-assessed based on DELBI. Results from aggregative studies included in selected CPGs were obtained. Results Pharmacotherapy doubles smoking cessation rates as compared with placebos (rates @25% and up to 27 % when combined with counseling). The highest efficacy was observed for ansyolitic and antidepressive drugs (8.7 % to 19.4 %), and the lowest for nicotine replacement therapy -NRT- (5.2 % to 12.9 %). Nortriptiline shows an efficacy similar to that of bupropion (@10%). With limited exceptions, combined pharmacotherapy for smoking cessation has shown no significant increase in cessation rates. Conclusions NRT, varenicline, bupropion and nortriptiline are effective treatments for smoking cessation. Combination of drugs deserves further clinical evidence and should be restricted to highly dependent smokers or initial therapeutic failure. Cost-effectiveness analyses might help to introduce smoking cessation programs in low and middle income countries.
Asunto(s)
Humanos , Guías de Práctica Clínica como Asunto , Cese del Hábito de Fumar , Dispositivos para Dejar de Fumar Tabaco , Ansiolíticos/efectos adversos , Ansiolíticos/uso terapéutico , Antidepresivos/efectos adversos , Antidepresivos/uso terapéutico , Arritmias Cardíacas/inducido químicamente , Bupropión/efectos adversos , Bupropión/uso terapéutico , Dolor en el Pecho/inducido químicamente , Clonidina/efectos adversos , Clonidina/uso terapéutico , Colombia , Análisis Costo-Beneficio , Vías de Administración de Medicamentos , Erupciones por Medicamentos/etiología , Quimioterapia Combinada , Enfermedades Gastrointestinales/inducido químicamente , Mucositis/inducido químicamente , Nortriptilina/efectos adversos , Nortriptilina/uso terapéutico , Trastornos del Inicio y del Mantenimiento del Sueño/inducido químicamente , Cese del Hábito de Fumar/economía , Cese del Hábito de Fumar/métodos , Dispositivos para Dejar de Fumar Tabaco/efectos adversos , Dispositivos para Dejar de Fumar Tabaco/economía , Resultado del Tratamiento , Vareniclina/efectos adversos , Vareniclina/uso terapéuticoAsunto(s)
Humanos , Adulto , Trastornos Relacionados con Cocaína/complicaciones , Síndrome Coronario Agudo/etiología , Síndrome Coronario Agudo/inducido químicamente , Síndrome Coronario Agudo/terapia , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/etiología , Dolor en el Pecho/inducido químicamente , Cocaína/efectos adversos , Cocaína/farmacologíaRESUMEN
Background & objectives: Chemical pleurodesis is an accepted therapy for patients with recurrent pleural effusions and pneumothorax. Iodopovidone has been shown to be safe and effective for chemical pleurodesis in several studies. The aim of this systematic review was to update a previously reported meta-analysis on the efficacy and safety of iodopovidone pleurodesis. Methods: Two databases MEDLINE and EMBASE were searched for a period (1952-2010), and studies that have reported success rates with iodopovidone pleurodesis were selected. The proportions with 95 per cent confidence interval (CI) were calculated to assess the outcomes in the individual studies and the results were pooled using a random effects model. Results: Thirteen eligible studies with 499 patients were included in the mata-analysis. The success rates varied from 70 to 100 per cent in different studies with the pooled success rate being 88.7 per cent (95% CI, 84.1 to 92.1). The success rate was not affected by the method (tube thoracostomy vs. thoracoscopy, 89.6 vs. 94.2%) or the indication of pleurodesis (pleural effusion vs. pneumothorax, 89.2 vs. 94.9%). The only significant complication reported was chest pain of varying degree. Systemic hypotension was reported in six patients across the studies. There were no deaths associated with iodopovidone pleurodesis. Statistical heterogeneity and publication bias were found. Interpretation & conclusions: Iodopovidone may be considered a safe and effective agent for chemical pleurodesis in patients with pleural effusions and recurrent pneumothoraces.