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Smoking cessation interventions in COPD: a network meta-analysis of randomised trials

¹ Horten Centre for patient-oriented research and knowledge transfer, University of Zurich, and ⁴ Division of Pneumology, University Hospital of Zurich, Zurich, Switzerland. ² Kleijnen Systematic Reviews Ltd, York, UK. ³ School for Public Health and Primary Care, CAPHRI, University of Maastricht, Maastricht, The Netherlands. ⁵ Dept of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

CORRESPONDENCE: M. A. Puhan, Dept of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, 21205 Baltimore, MD, USA. E-mail: mpuhan{at}jhsph.edu

Keywords: Chronic obstructive pulmonary disease, mortality, network meta-analysis, prolonged abstinence rates, randomised trials, smoking cessation

Received: November 5, 2008
Accepted March 31, 2009

The aim of this study was to rank order the effectiveness of smoking cessation interventions for chronic obstructive pulmonary disease (COPD) patients.

We searched 10 databases to identify randomised trials of smoking cessation counselling (SCC) with or without pharmacotherapy or nicotine replacement therapy (NRT). We conducted a network meta-analysis using logistic regression analyses to assess the comparative effectiveness of smoking cessation interventions while preserving randomisation of each trial.

The analysis of 7,372 COPD patients from six out of eight identified trials showed that SCC in combination with NRT had the greatest effect on prolonged abstinence rates versus usual care (OR 5.08, p<0.0001) versus SCC alone (2.80, p = 0.001) and versus SCC combined with an antidepressant (1.53, p = 0.28). The second most effective intervention was SCC combined with an antidepressant (3.32, p = 0.002) versus SCC alone (1.83, p = 0.007), with no difference between antidepressants. SCC alone was of borderline superiority compared with usual care (1.81, p = 0.07).

A small body of evidence suggests that SCC combined with NRT is more effective than other combinations and single smoking cessation treatments in COPD, but substantially more research is needed for this most important COPD treatment.