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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
Cañas, Alejandra; Alba, Luz-H; Becerra, Nelci; Murillo, Raúl; Páez, Nelson; Mosquera, Catalina.
  • Cañas, Alejandra; Hospital Universitario San Ignacio. Pontificia Universidad Javeriana. Bogotá. CO
  • Alba, Luz-H; Hospital Universitario San Ignacio. Pontificia Universidad Javeriana. Bogotá. CO
  • Becerra, Nelci; Hospital Universitario San Ignacio. Pontificia Universidad Javeriana. Bogotá. CO
  • Murillo, Raúl; Hospital Universitario San Ignacio. Pontificia Universidad Javeriana. Bogotá. CO
  • Páez, Nelson; Hospital Universitario San Ignacio. Pontificia Universidad Javeriana. Bogotá. CO
  • Mosquera, Catalina; Hospital Universitario San Ignacio. Pontificia Universidad Javeriana. Bogotá. CO
Rev. salud pública ; 16(5): 661-673, set.-oct. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-743928
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.
ABSTRACT
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.
Subject(s)

Full text: Available Index: LILACS (Americas) Main subject: Smoking Cessation / Practice Guidelines as Topic / Tobacco Use Cessation Devices Type of study: Controlled clinical trial / Etiology study / Practice guideline / Systematic reviews Limits: Humans Country/Region as subject: South America / Colombia Language: Spanish Journal: Rev. salud pública Journal subject: Public Health Year: 2014 Type: Article Affiliation country: Colombia Institution/Affiliation country: Hospital Universitario San Ignacio/CO

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Full text: Available Index: LILACS (Americas) Main subject: Smoking Cessation / Practice Guidelines as Topic / Tobacco Use Cessation Devices Type of study: Controlled clinical trial / Etiology study / Practice guideline / Systematic reviews Limits: Humans Country/Region as subject: South America / Colombia Language: Spanish Journal: Rev. salud pública Journal subject: Public Health Year: 2014 Type: Article Affiliation country: Colombia Institution/Affiliation country: Hospital Universitario San Ignacio/CO