Pharmacological intervention on smoking cessation of drinking smokers: a network meta-analysis of randomized controlled trials

Background: and Aim: Some clinical trials have reported on the treatment of alcohol-drinking smokers with drugs. This network meta-analysis aims to explore the effect of pharmacological interventions on smoking cessation in such populations. Methods: Only randomized controlled trials (RCTs) were included through a system and comprehensive database search. The risk of bias for the included studies were assessed using Cochrane tool. A network meta-analysis was performed using STATA software to evaluate the effect size between different comparisons, and provide the best smoking cessation intervention based on the SUCRA value. Results: A total of 15 RCTs involving 1565 participants were included. The risk of bias was low in five studies and unclear in ten studies. Network meta-analysis showed that the superiority of quitting smoking was reflected in Varenicline vs Placebo (OR=4.90, 95%CI [1.77,13.55]), Varenicline vs Naltrexone (OR=3.50, 95%CI [1.13,11.06]), and Varenicline vs Bupropion (OR=3.32, 95%CI [1.03,10.74]). None of the other pairwise comparisons showed significant difference. Finally, the probability ranking results indicated that Varenicline was the most effective intervention. Conclusions: The network meta-analysis showed that compared with Naltrexone, Bupropion, and Placebo, Varenicline had obvious superiority in quitting smoking, while there was no difference in effect between other drugs. Meanwhile, we look forward to more high-quality studies to investigate the existing evidence.