Efficacy and acceptability of varenicline for alcoholism: A systematic review and meta-analysis of randomized-controlled trials

Oon-arom, Awirut; Likhitsathain, Surinporn; Srisurapanont, Manit

doi:10.1016/j.drugalcdep.2019.107631

Cited by 22 publications

(19 citation statements)

References 34 publications

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“…Varenicline may be a promising treatment for post-smoking cessation nicotine use in individuals who continue to use nicotine replacement products for years 106 . Finally, varenicline has shown some potential for indications beyond smoking cessation, including for alcohol use disorder and addiction treatment for other drugs such as cocaine [107][108][109] . Additional research could also confirm these uses.…”

Section: Discussionmentioning

confidence: 99%

Varenicline: mode of action, efficacy, safety and accumulated experience salient for clinical populations

Tonstad

Arons

Rollema³

et al. 2020

Current Medical Research and Opinion

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Objective: Varenicline, a selective partial agonist of the a4b2 nicotinic acetylcholine receptor, is a smoking cessation pharmacotherapy that more than doubles the chance of quitting smoking at 6 months compared with placebo. This article reviews salient knowledge of the discovery, pharmacological characteristics, and the efficacy and safety of varenicline in general and in specific populations of smokers and provides recommendations to support use in clinical practice. Methods: Literature searches for varenicline were conducted using PubMed, with date limitations of 2000-2018 inclusive, using search terms covering the discovery, mechanism of action, pharmacokinetics, efficacy and safety in different populations of smokers, alternative quit approaches and combination therapy. Selection of safety and efficacy data was limited to clinical trials, meta-analyses and observational studies. Results: Standard administration of varenicline is efficacious in helping smokers to quit, including smokers with cardiovascular disease and chronic obstructive pulmonary disease. Furthermore, varenicline efficacy may be improved with pre-loading, a gradual quitting approach for smokers unwilling or unable to quit abruptly, and extended treatment in smokers who have recently quit to help maintain abstinence. Initial concerns regarding the association of varenicline with increased risk of neuropsychiatric and cardiovascular adverse events have been disproven after extensive clinical evaluations, and the benefit-risk profile of varenicline is considered favorable. Conclusions: Varenicline is efficacious and safe for all adult smokers with a range of clinical characteristics. Evidence suggests that approaches offering greater flexibility in timing and duration of treatment may further extend treatment efficacy and clinical reach.

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Section: Discussionmentioning

confidence: 99%

Varenicline: mode of action, efficacy, safety and accumulated experience salient for clinical populations

Tonstad

Arons

Rollema³

et al. 2020

Current Medical Research and Opinion

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“…For example, Kishi et al [38] conducted a systematic review to explore the effect of Varenicline on smoking cessation, and found that Varenicline was not superior to placebo for promoting smoking cessation in people with schizophrenia. Meanwhile, Oon-Arom [39] separately synthesized the evidence for Varenicline on alcoholism. These two studies show that Varenicline is a relatively important drug in the treatment of addictive behaviors.…”

Section: Comparisons With Other Studies or Reviewsmentioning

confidence: 99%

The Effects of Pharmacological Interventions on Smoking Cessation in People with Alcohol Dependence: A Systematic Review and Meta-analysis of Nine Randomized Controlled Trials

Guo

et al. 2021

Preprint

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Background Pharmacotherapies are widely used for smoking cessation. However, their effect on smoking cessation for people with alcohol dependence remains unclear. Objective This study aimed to explore the effects of pharmacotherapies on smoking cessation for people with alcohol dependence. Methods Five electronic databases were searched in January 2021 for randomized controlled trials (RCTs) reporting the use of pharmacotherapies to promote smoking cessation in people with alcohol dependence. The risk of bias was assessed using the Cochrane tool. RevMan version 5.3 was used to perform meta-analyses of the changes in smoking behavior, and the GRADE approach was used to assess the certainty of the evidence. Results Nine RCTs involving 908 smokers with alcohol dependence were identified. Eight RCTs were published in the United States, and one was from Canada. The risk of bias was rated as low in three studies and unclear in the remaining six. The results of the meta-analysis showed that, compared with the placebo group, Varenicline had a significant effect on short-term smoking cessation (three RCTs, OR = 6.27, 95% CI: [2.49, 15.78], p < 0.05, very low certainty). Naltrexone had no significant effect on smoking cessation in short-term or long-term observations (three RCTs, OR = 0.99, 95% CI: [0.54, 1.81], p = 0.97, moderate certainty), and Topiramate had no significant effect (two RCTs, OR = 1.56, 95% CI: [0.67, 3.46], p > 0.05, low certainty). Only one trial reported that Bupropion had no effect on smoking cessation. Conclusion Varenicline may have a positive effect on smoking cessation in people with alcohol dependence. However, Naltrexone, Topiramate, and Bupropion seem to have no clear effect on increasing smoking abstinence among drinkers. The small number of studies and the low certainty of evidence indicate that caution is required in interpreting the results.

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“…A meta-analysis of the effectiveness of drugs for relapse prevention in alcohol dependent individuals concluded that the efficacy of valproate and disulfiram must be considered insufficient with regard to the previously established target criteria of drinking quantity reduction (heavy drinking, number of heavy drinking days, drinks per drinking day; Jonas et al, 2014). According to a systematic review and meta-analysis, Varenicline has shown some promise in the reduction of average alcohol intake but not in the reduction of number of heavy drinking days (Oon-Arom et al, 2019).…”

Section: Baclofenmentioning

confidence: 99%

Reduced drinking and harm reduction in the treatment of alcohol use disorders

Bischof¹,

Lange²,

Rumpf³

et al. 2020

DAT

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Purpose The purpose of this paper is to give an overview of the scientific evidence for reduced drinking in alcohol use disorders. While the aim of alcohol use disorders (AUD) treatment usually focuses on abstinence, only a minority of individuals with AUD enter treatment. Lack of alternative treatment goals, including reduced drinking instead of abstinence, have been identified as a potential barrier for treatment entry. Epidemiological and treatment outcome studies reveal that a large proportion of individuals with AUD are able to substantially reduce their alcohol intake for a prolonged duration of time. Design/methodology/approach A narrative review of the literature on prevalence rates and health effects as well as evidence-based approaches fostering reduced drinking in individuals with AUD is presented. Findings Reduced drinking is associated with improvements in both morbidity and mortality. Research has identified evidence-based psychosocial and pharmacological treatment approaches; however, implementation is still scarce. Originality/value Target groups for interventions fostering drinking reduction instead of abstinence are defined and desiderata for further research are outlined.

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Efficacy and acceptability of varenicline for alcoholism: A systematic review and meta-analysis of randomized-controlled trials

Cited by 22 publications

References 34 publications

Varenicline: mode of action, efficacy, safety and accumulated experience salient for clinical populations

Varenicline: mode of action, efficacy, safety and accumulated experience salient for clinical populations

The Effects of Pharmacological Interventions on Smoking Cessation in People with Alcohol Dependence: A Systematic Review and Meta-analysis of Nine Randomized Controlled Trials

Reduced drinking and harm reduction in the treatment of alcohol use disorders

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