Eficácia e segurança de Duloxetina comparado a outros antidepressivos disponíveis no SUS para o tratamento de depressão maior: revisão rápida de evidências / Effectiveness and safety of Duloxetine compared to other antidepressant agents available in Brazilian Public Health for treatment of major depression: rapid response review of evidence

Tecnologia: Duloxetina e outros antidepressivos disponíveis no Sistema Único de Saúde (amitriptilina, nortriptilina, clomipramina, fluoxetina e bupropiona). Indicação: Tratamento do primeiro episódio depressivo no transtorno de depressão maior em adultos. Pergunta: A duloxetina é mais eficaz e tolerável que a amitriptilina, nortriptilina, clomipramina, fluoxetina e bupropiona para o tratamento do primeiro episódio de depressão maior em adultos? Métodos: Revisão rápida de evidências (overview) de revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PUBMED, utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada com AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews). Resultados: Foi selecionada 1 revisão sistemática, que atendia aos critérios de inclusão. Conclusão: Os antidepressivos, comparados ao placebo, tinham maior taxa de resposta, taxa de remissão e taxa de descontinuação devido a efeitos colaterais, no tratamento de curto prazo. Duloxetina tinha taxa de resposta similar a amitriptilina, clomipramina, fluoxetina e bupropiona. Duloxetina e amitriptilina tinham maior taxa de remissão que fluoxetina. Comparando-se as taxas de abandono de tratamento devido a efeitos colaterais, clomipramina era menos seguro, amitriptilina, bupropiona e duloxetina eram parecidos entre si, e fluoxetina era o antidepressivo mais seguro

Technology: Duloxetine and other antidepressants available in the Brazilian Public Health System (amitriptyline, nortriptyline, clomipramine, fluoxetine and bupropion). Indication: Treatment of the first depressive episode in adult major depressive disorder. Question: Is duloxetine more effective and tolerable than amitriptyline, nortriptyline, clomipramine, fluoxetine and bupropion for the treatment of first episode of major depression in adults? Methods: Rapid response review of evidence (overview) from systematic reviews, with a bibliographic search in the PUBMED database, using a structured strategy. The methodological quality of systematic reviews was assessed with AMSTAR-2 (Methodological Quality Assessment of Systematic Reviews). Results: One systematic review was selected, which met the inclusion criteria. Conclusion: In short-term treatment, antidepressants, compared to placebo, had a higher rate of response, rate of remission and rate drop-out due to side effects. Duloxetine had a similar response rate to amitriptyline, clomipramine, fluoxetine and bupropion. Duloxetine and amitriptyline had higher remission rates than fluoxetine. Comparing rates of dropout due to side effects, clomipramine had the worst rates, amitriptyline, bupropion, and duloxetine were similar to each other, and fluoxetine had the better rates

Lisdexanfetamina comparada a Metilfenidato ou antidepressivos no tratamento de TDAH em crianças e adolescentes: revisão rápida de evidências / Lisdexamfetamine compared to Methylphenidate or antidepressants for treatment of ADHD: rapid response review of evidence

Lisdexanfetamina e drogas disponíveis no SUS (metilfenidato, bupropiona, amitriptilina, clomipramina, nortriptilina). Indicação: Transtorno do Déficit de Atenção e Hiperatividade (TDAH) em crianças e adolescentes. Pergunta: Lisdexanfetamina é eficaz e segura para melhoria de sintomática, comparada ao placebo e medicações disponíveis no SUS, no tratamento de crianças e adolescentes com TDAH? Métodos: Revisão rápida de evidências (overview) de revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PUBMED, utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada com AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews). Resultados: Foram selecionadas 3 revisões sistemáticas, que atenderam aos critérios de inclusão. Conclusão: Lisdexanfetamina e metilfenidato são mais eficazes que placebo, e similares entre si, para reduzir sintomas em escalas de avaliação. Lisdexanfetamina e metilfenidato têm risco similar ao placebo de abandono do tratamento devido a efeitos adversos. Bupropiona não é mais eficaz que placebo para alívio sintomático. Lisdexanfetamina tem efeitos adversos de redução do apetite e insônia/ dificuldades do sono. Não foram encontradas evidências na literatura sobre os efeitos terapêuticos de amitriptilina, clomipramina e nortriptilina no tratamento de crianças e adolescentes com TDAH

Lisdexamfetamine and drugs available in the Brazilian Public Health System (BPHS) (methylphenidate, bupropion, amitriptyline, clomipramine, nortriptyline, bupropion). Indication: Children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). Question: Lisdexamfetamine is effective and safe for symptomatic improvement, compared to placebo and drugs available in the BPHS, for treatment of children and adolescents with ADHD? Methods: Rapid response review of evidence (overview) of systematic reviews, with bibliographic search in the PUBMED database, using a structured strategy. The methodological quality of systematic reviews was assessed with AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews). Results: 3 systematic reviews met the inclusion criteria and were selected. Conclusion: Lisdexamfetamine and methylphenidate are more effective than placebo, and similar to each other, to reduce symptoms on rating scales. Lisdexamfetamine and methylphenidate are not different from placebo in the risk of treatment discontinuation due to adverse effects. Bupropion is no more effective than placebo for symptomatic relief. Lisdexamfetamine has adverse effects of decreased appetite and insomnia/sleep troubles. No evidence was found in the literature about therapeutic effects of amitriptyline, clomipramine and nortriptyline for treatment of children and adolescents with ADHD

Guías de Práctica Clínica para el Tratamiento del Tabaquismo, Chile 2017 / Clinical Practice Guidelines for Smoking Cessation

Considering that a high proportion of the Chilean general population smokes, the Chilean Society of Respiratory Diseases in collaboration with the Chilean Societies of Cardiology and, Endocrinology and Diabetes, formed an interdisciplinary group, who issued a set of recommendations for the treatment of the smoker, methodologically advised by experts. These interventions should be prioritized in high-risk groups. Methods The panel elaborated and graded the recommendations following the GRADE methodology. To assess the effect of each intervention, systematic reviews and randomized clinical trials were identified. In addition, a search of studies done with the Chilean population was carried out. For each of the questions, the panel determined the direction and strength of the recommendation through a decision evidence table. Recommendations For all smokers, the panel recommends using brief counseling ABC on non-intervention, using mobile telephone interventions on non-intervention, using text message on non-intervention, (strong recommendation; moderate certainty in the evidence of the effects). For motivated individuals, with indication for quitting drugs the panel recommends using nicotine replacement therapy on non-intervention, using bupropion on non-intervention, using varenicline on non-intervention. (strong recommendation; moderate certainty in the evidence of the effects). Discussion This clinical practice guide provides recommendations based on the evidence for smoking cessation.

El propósito de esta guía es presentar recomendaciones basadas en evidencia sobre las intervenciones disponibles para dejar de fumar. Su audiencia objetivo corresponde a todos los profesionales de la salud y su población objetivo corresponde a personas fumadoras atendidas en ambientes ambulatorios u hospitalarios, además de poblaciones especiales como embarazadas, adolescentes y pacientes con enfermedad psiquiátrica (compensada por al menos tres meses).

Guías de Práctica Clínica para el Tratamiento del Tabaquismo, Chile 2017 / Clinical Practice Guidelines for Smoking Cessation

RESUMEN Considerando que la población chilena tiene una historia de alto consumo de tabaco la Sociedad Chilena de Enfermedades Respiratorias en colaboración con las Sociedades Chilenas de Cardiología; Endocrinología y Diabetes formó un grupo interdisciplinario que emitió un conjunto de recomendaciones para el enfrentamiento del paciente fumador, asesorado metodológicamente por expertos. Estas intervenciones deben priorizarse en grupos de alto riesgo. Métodos: El panel elaboró y graduó las recomendaciones siguiendo la metodología GRADE. Para estimar el efecto de cada intervención, se identificó revisiones sistemáticas y estudios clínicos aleatorizados. Además, se realizó una búsqueda de estudios realizados con población chilena. Para cada una de las preguntas, el panel determinó la dirección y fuerza de la recomendación mediante una tabla de la Evidencia a la Decisión. Recomendaciones: Para todos los fumadores, el panel recomienda usar consejería breve sobre no intervención, consejería vía telefonía móvil sobre no intervención, y mensajes de texto sobre no intervención (recomendación fuerte; certeza moderada en la evidencia de los efectos). Para los individuos motivados, con indicación de fármacos para dejar de fumar el panel recomienda terapia de reemplazo de nicotina sobre no intervención, bupropión sobre no intervención, vareniclina sobre no intervención (recomendación fuerte; certeza moderada en la evidencia de los efectos). Discusión: Se emiten recomendaciones basadas en la evidencia para el tratamiento del tabaquismo.

Considering that Chilean population has a high tobacco consumption history, the Chilean Society of Respiratory Diseases in collaboration with the Chilean Societies of Cardiology and, Endocrinology and Diabetes, formed an interdisciplinary group, who issued a set of recommendations for the treatment of the smoker, methodologically advised by experts. These interventions should be prioritized in high-risk groups. Methods: The panel elaborated and graded the recommendations following the GRADE methodology. To assess the effect of each intervention, systematic reviews and randomized clinical trials were identified. In addition, a search of studies done with the Chilean population was carried out. For each of the questions, the panel determined the direction and strength of the recommendation through a decision evidence table. Recommendations: For all smokers, the panel recommends using brief counseling ABC on non-intervention, using mobile telephone interventions on non-intervention, using text message on non-intervention, (strong recommendation; moderate certainty in the evidence of the effects). For motivated individuals, with indication for quitting drugs the panel recommends using nicotine replacement therapy on non-intervention, using bupropion on non-intervention, using varenicline on non-intervention. (strong recommendation; moderate certainty in the evidence of the effects). Discussion: This clinical practice guide provides recommendations based on the evidence for smoking cessation.

Bupropión: una alternativa farmacológica en cesación tabáquica / Bupropion: a pharmacological alternative in smoking cessation

Resumen Hay muchas razones para el uso de antidepresivos en cesación tabáquica: 1) la falta de nicotina puede producir síntomas depresivos o precipitar un episodio depresivo grave; 2) la nicotina puede tener efectos antidepresivos que mantienen la adicción; 3) algunos antidepresivos tienen una acción en vías neuronales o receptores implicados en la adicción a la nicotina; y 4) algunos pacientes no desean usar otras terapias o han fracasado con ellas. Bupropión es terapia de primera línea para la cesación del tabaco, con efectividad a largo plazo, los efectos adversos graves son escasos. La evidencia sugiere que bupropión es de eficacia similar a la terapia de reemplazo de nicotina (TRN) y menos eficaz que vareniclina, pero se necesita más estudios para confirmar esto. Bupropión es seguro en pacientes psiquiátricos compensados en un periodo de tres meses o más.

There are many reasons for the use of antidepressants in smoking cessation: 1) lack of nicotine can produce depressive symptoms or precipitate a severe depressive episode; 2) nicotine may have antidepressant effects that maintain addiction; 3) some antidepressants have an action on neural pathways or receptors involved in nicotine addiction; and 4) some patients do not want to use other therapies or they have failed with them. Bupropion is first-line therapy for smoking cessation, with long-term effectiveness, serious side effects are rare. The evidence suggests bupropion is similar in effectiveness to nicotine replacement therapy (NRT), and less effective than varenicline, but more studies are needed to confirm this. Bupropion is safe in psychiatric patients compensated over a period of three months or more.

Vareniclina / Varenicline

Resumen Vareniclina es terapia de primera línea para la cesación del tabaquismo, y presenta la mayor efectividad demostrada ampliamente en ensayos clínicos logrando cifras de abandono al año del orden de 25-35%. En la más reciente revisión de efectividad realizada por la Cochrane se evaluaron 39 ensayos que randomizaban vareniclina contra placebo y en comparación con sustitutos de nicotina (TRN) y bupropión. Con vareniclina se objetivó un RR de 2,24 para abstinencia a 6 meses o más prolongado a dosis standard (2 mg al día) contra placebo. El RR de vareniclina versus placebo comparando con bupropión o TRN fue de 1,3 y 1,25 respectivamente mostrando su superioridad una vez más. Cuando se evaluó el uso de vareniclina por un periodo más prolongado que 12 semanas, se observó que la droga fue bien tolerada sugiriendo que es factible su uso sin intensificar los efectos adversos.

Varenicline is a first-line therapy cessation of smoking, and has the highest effectiveness widely demonstrated in clinical trials with drop-out figures per year of the order of 25-35%. In the most recent effectiveness review conducted by the Cochrane, 39 trials were evaluated that randomized varenicline versus placebo and compared with nicotine substitutes (NRT) and bupropion. With varenicline, a RR of 2.24 was observed for abstinence at 6 months or longer at standard doses (2 mg daily) versus placebo. The RR of varenicline versus placebo compared with bupropion or NRT was 1.3 and 1.25 respectively showing its superiority once again. When the use of varenicline was evaluated for a period longer than 12 weeks, it was observed that the drug was well tolerated suggesting that its use is feasible without intensifying the adverse effects.

Revisión sistemática de estudios de costo-efectividad y análisis de transferibilidad de intervenciones sanitarias para la cesación del hábito tabáquico / Systematic review of cost-effectiveness studies and transferability analysis of health interventions for cessation of smoking

Objetivo: El objetivo de este estudio fue conocer la eficiencia de las estrategias de consejería breve (CB), terapia de reemplazo de la nicotina (TRN) y el uso de medicamentos como el bupropión y la vareniclina. Para \r\nlo cual se plantearon las siguientes preguntas de investigación: Son la consejería breve, la terapia de reemplazo de nicotina en combinación con CB y/o las terapias farmacológicas con vareniclina o bupropión asociadas a CB, intervenciones costo-efectivas en la cesación del hábito tabáquico? Son transferibles los resultados de los estudios que evalúan la costo-efectividad de la consejería breve, terapia de reemplazo de nicotina y/o terapias farmacológicas con vareniclina o bupropión al contexto chileno? Metodología: Se realizó una búsqueda sistemática de la literatura en MEDLINE y CRD (Centre for Reviews and Dissemination) de estudios publicados entre los años 2004 y 2014, que evaluaran la costo-efectividad de la consejería breve, terapia de reemplazo de la nicotina y terapias farmacológicas con bupropión o vareniclina como estrategias para el cese del hábito tabáquico en población general. Conclusiones: Todas las intervenciones evaluadas fueron costo-efectivas al compararlas con CSA. Las terapias farmacológicas asociadas a CB demostraron ser más costo-efectivas que la CB por sí sola. Vareniclina +CB resultó ser una intervención dominante en relación a sus comparadores.Vareniclina domina todas las otras terapias, por lo que debiera ser considerada como la terapia de elección en fumadores en su primer intento para dejar de fumar. La inclusión de vareniclina asociada a consejería breve en el Sistema Nacional de Salud, reduciría la morbilidad y la mortalidad relacionada con el tabaquismo en Chile, resultando en importantes ahorros económicos en salud.

Eficacia y seguridad del uso de medicamentos para la cesación de la adicción al tabaco: revisión de guías de práctica clínica / Efficacy and safety of medication use for the cessation of tobacco addiction: Are view of Clinical Practice Guidelines

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.

Resultados de un programa multidisciplinario para el control del hábito tabáquico / Results of a multidisciplinary program to quit smoking

Background: Therapies to quit smoking are based on counseling, psychological therapy (PT), nicotine replacement therapy, bupropion or varenidine. Aim: To report the results of a multidisciplinary program to quit smoking Material and Methods: Patients agedl8years or more, motivated to quit smoking were admitted in a program based in counseling and PT, with or without pharmacological therapy. They were assessed by telephone during one year offollow up. Patients with unstable psychiatric diseases were excluded. Results were considered as "successful" when patients maintained abstinence during the year offollow up. A logistic regression analysis was done to identify factors associated with treatment success. Results: Between 2005 and 2011, 198 patients aged 45 ± 11 years (56% males), who smoked 31.5 ± 20.6 packages/year, were treated. Ofthese, 155 (78%) were treated with varenidine, 26 (13%) with bupropion and 17 (9%>) did not receive pharmacological therapy. One hundred sixty eightpatients completed the year offollow up. In 82 (49%>), treatment was successful and was negatively associated with a history of depression (odds ratio = 4 (95% confidence intervals 1.23-38.33). The main side effeets associated to varenidine and bupropion were nausea in 37 and 23%o, sleep disorders in 20 and 19%o and headache in 12 and 0%>, respectively Conclusions: A multidisciplinary program to quit smoking achieved a 49%> of abstinence during a year offollow up.

A real-life study of the effectiveness of different pharmacological approaches to the treatment of smoking cessation: re-discussing the predictors of success

OBJECTIVE: To evaluate the effectiveness of nicotine replacement therapy (NRT), bupropion, nortriptyline and combination therapy and describe factors associated with treatment success. INTRODUCTION: Clinical trials clearly demonstrate the efficacy of pharmacotherapy in smoking cessation. However, it is only after its use in real-life settings that clinical effectiveness and limitations of a treatment are fully known. METHODS: Patients attended a four-session cognitive-behavioral program and received medicines free of charge. Abstinence from smoking was assessed at each visit. RESULTS: A total of 868 smokers (68.8 percent women) were included. Their mean age was 49.6 years; the amount smoked was 25 cigarettes/day and the Fagerströ m Score was 6.6. Abstinence rates after 6 months and 1 year were 36.5 percent and 33.6 percent. In univariate analysis, male gender, age (>50), higher number of cigarettes smoked, cardiovascular comorbidities, longer interval from the last cigarette and combined treatment of nortriptyline plus NRT were predictive of abstinence, while neuropsychiatric comorbidities and the answer ''yes'' to the question ''Do you smoke more often during the first hours after waking'' were correlated with failure. In a multivariate model, predictors of abstinence were neuropsychiatric comorbidities, the answer ''yes'' to the question ''Do you smoke more often during the first hours after waking'' and combined treatment of nortriptyline plus NRT. Male gender and a longer period from the last cigarette were correlated with lower abstinence rate. CONCLUSION: Satisfactory success rates were obtained in a teaching hospital. Factors such as age, daily cigarette consumption, number of pack-years and dependency score were not reliable markers of abstinence. The combination nortriptyline+NRT was independently associated with higher abstinence rates.

Bupropion and paraxetine do not affect natural killer cell activity in vitro / Antidepressivos inibidores seletivos de recaptação da serotonina e inibidores da recaptação de noradrenalina e dopamina não afetam a atividade celular natural killer in vitro

OBJETIVO: Avaliar o efeito citotóxico de dois antidepressivos comumente utilizados na prática, a paroxetina e a bupropriona. Além disso, buscou-se avaliar a atividade natural killer (ANK) após a incubação dos linfócitos com esses fármacos. MÉTODOS: Sangue venoso de 15 participantes foi coletado e as células mononucleares (PBMCs) foram separadas e incubadas por 24h com (ou sem = grupo-controle) concentrações de paroxetina e bupropiona em 30, 100 e 1.000 ng/ml. Após a incubação, a quantidade das células mortas foi contada utilizando-se o método trypan blue. Posteriormente foi avaliada a ANK por meio do ensaio clássico de liberação do Cr51. CONCLUSÕES: Ocorreu morte celular de PBMCs proporcionais às doses dos fármacos, no entanto, a ANK não foi afetada, mesmo com a redução do número de células efetoras.

Objective: This study aims to evaluate the citotoxic activity of two commonly used anti-depressants: paroxetine and bupropion. We also evaluated the in vitro natural killer activity (NKA) afterincubating the blood samples with the antidepressants. Methods: Peripheral blood samples from 15 healthy volunteers were collected and the mononuclear cells (PBMCs) were isolated and incubated for 24h with (or without = control cells) paroxetine and bupropion, in concentrations of 30, 100 and 1000 ng/ml. After the incubation period in both groups, the amount of dead cells was calculated using trypam blue technique. NKA was evaluated using the classic51Cr release assay. Conclusions: PBMCs dead cells occurred in both groups and in proportion to all pharmacological concentrations. Nevertheless, the NKA was not affected, even with the reduction in the number of effective cells.

Determination and support as successful factors for smoking cessation / La determinación y el apoyo como factores de éxito en el abandono del tabaquismo / Determinação e apoio como fatores de sucesso no abandono do tabagismo

This study aimed to analyze determination and support as successful factors for smoking cessation. Qualitative study in which 16 individuals from Porto Alegre, Brazil, who had ceased smoking for more than six months, with score > 5 according to Fagerstrõm scale, were interviewed. Information was examined through Content Analysis according to the following steps: pre-analysis, material investigation and result treatment. Smoking cessation was a consequence of a group of factors, with determination (the will to cease smoking and the difficulty to cease smoking) and the received support (occupational; family; social, and spiritual, and through a specific course and support groups) as the focus of this article. The results suggest that the smoker's determination to cease smoking together with the support of society segments and the benefits from that are helpful factors in the smoking cessation process.

Este estudio tuvo como objetivo analizar los factores que contribuyen para obtener éxito en abandonar el tabaquismo. Es un estudio cualitativo, en el cual fueron entrevistados 16 individuos de Porto Alegre, en Brasil, que dejaron de fumar hace más de seis meses, con puntuación > 5 de la escala de Fagerstrõm. Las informaciones fueron examinadas por un Análisis de Contenido, por medio de las etapas de análisis, examen del material y tratamiento de los resultados. El abandono del tabaquismo es el resultado de un conjunto de factores, siendo el foco de este artículo la determinación (querer parar y la dificultad de parar de fumar) y el apoyo recibido (profesional, familiar, social y espiritual). Los resultados sugieren que la determinación del fumador de querer parar de fumar, aliada al apoyo de segmentos de la sociedad son factores que ayudan de forma significativa para el proceso de abandono del tabaquismo.

Este estudo teve por objetivo analisar fatores que contribuem para o sucesso no abandono do tabagismo. Estudo qualitativo, no qual foram entrevistados 16 indivíduos de Porto Alegre, RS, Brasil, que pararam de fumar há mais de seis meses, com pontuação >5 pela escala de Fagerstrõm. As informações foram examinadas através da Análise de Conteúdo, por meio das etapas de pré-análise, exploração do material e tratamento dos resultados. O abandono do tabagismo resultou de um conjunto de fatores, sendo foco deste artigo a determinação (querer parar e dificuldade de parar de fumar) e o apoio recebido (profissional, familiar, social e espiritual). Os resultados sugerem que a determinação do fumante de querer parar de fumar, aliada ao apoio de segmentos da sociedade são fatores que auxiliam de forma significativa o processo de abandono do tabagismo.

Factores determinantes en el éxito de un tratamiento antitabaco / Factors associated with abstinence in a smoking cessation program

Smoking cessation programs have an efficacy of approximately 30 percent. Different factors related to the patients may influence this figure. Aim To identify determinant factors for smoking cessation after one year of treatment and to determine if bupropion and nicotine substitutes are effective in smoking cessation treatments. Material and methods: Follow up of 68 patients that attended a smokers clinic at a General Hospital. The patients filled up a questionnaire which included demographic, morbid and smoking habits data. They were subjected to a psychiatric interview to determine their treatment. One year later, patients were contacted by telephone and were asked if they remained without smoking. Results: After one year, 41 percent of patients responded that they were abstinent. On univariate analysis, male gender appeared as a protective factor associated to abstinence. On multivariate analysis, the use of bupropion appeared as a protective factor. A high score on the automatic item of the smoking motivation questionnaire appeared as a risk factor. The presence of respiratory diseases and the male gender were borderline significant protective factors. Nicotine substitutes were not associated with better abstinence rates. Conclusions: In this sample of smokers, the use of bupropion was associated with better abstinence rates and a high motivation to smoke appeared as a risk factor to continue smoking.

Tratamiento farmacológico del tabaquismo / Pharmacotherapy for tobbaco dependence

Currently, tobacco smoking is considered to be a chronic systemic disease that belongs to the group of addictions. Nicotine is the responsible substance of this dependence, producing a variety of disorders at the central nervous system, mainly through a raise of the dopamine levels. Tobacco dependence treatment has two main branches: psychosocial and pharmacological. Nicotine replacement therapy, Bupropion and Varenicline have been approved by the FDA as first-line treatments for nicotine dependence. There are some second-line drugs, such as Clonidine and Nortriptyline that have shown less efficacy and more adverse effects. Currently there are many other drugs in research, such as antinicotine vaccine and Rimonobant, that will probably be available for its use in the coming years. The current review analyzes the pharmacological choices existing today for treating tobacco dependence and those coming in the future.

Actualmente se considera que el tabaquismo es una enfermedad crónica sistémica, perteneciente al grupo de las adicciones. La nicotina es la sustancia responsable de esta dependencia, produciendo una serie de alteraciones en el SNC, principalmente mediante el aumento de dopamina. El tratamiento del tabaquismo incluye dos componentes: psicosocial y farmacológico. Hasta la actualidad, la FDA ha aprobado 3 medicamentos que han demostrado ser eficaces: Terapia de reemplazo de Nicotina, Bupropión y Vareniclina. Además existen drogas de segunda línea, como la Clonidina y Nortriptilina, menos eficaces y con mayores efectos adversos. Actualmente, hay muchos otros medicamentos en investigación, entre otros la Vacuna antinicotina y el Rimonobant, que probablemente estarán disponibles para su uso en los próximos años. En este artículo se analizan las alternativas farmacológicas existentes hoy en día para el tratamiento del tabaquismo y lo que podría venir en el futuro.