Silver acetate for smoking cessation

 

Abstract

Background

Silver acetate produces an unpleasant taste when combined with cigarettes, thereby producing an aversive stimulus. It has been marketed in various forms with the aim of extinguishing the urge to smoke, by pairing the urge with an unpleasant stimulus.

Objectives

The aim of this review was to determine the effectiveness of silver acetate products (gum, lozenge, spray) in promoting smoking cessation.

Search methods

We searched the Cochrane Tobacco Addiction Group trials register. Most recent search was in January 2009.

Selection criteria

We included randomised trials of silver acetate for smoking cessation with reports of smoking status at least six months after the beginning of treatment.

Data collection and analysis

We extracted data in duplicate on the type of subjects, the dose and form of silver acetate, the outcome measures, method of randomisation, and completeness of follow-up.

The main outcome measure was biochemically validated abstinence from smoking after at least six months follow-up in patients smoking at baseline. Subjects lost to follow-up were counted as continuing smokers. Where appropriate, we performed meta-analysis using a fixed effects model.

Main results

Two studies provided long-term follow-up data on patients randomised to silver acetate or placebo. In one of these studies, there was a third arm, randomised to 2mg nicotine gum. The combined odds ratio for quitting for silver acetate vs placebo was 1.05 (95% confidence interval 0.63 to 1.73).

Authors' conclusions

Existing trials show little evidence for a specific effect of silver acetate in promoting smoking cessation. The confidence intervals for the ratio are quite wide. However, the upper limit of the confidence intervals for a positive effect equates to an absolute increase in the smoking cessation rate of about 4%. Any effect of this agent is therefore likely to be smaller than nicotine replacement therapy. The lack of effect of silver acetate may reflect poor compliance with a treatment whose rationale is to create an unpleasant stimulus.

 

Plain language summary

Does silver acetate help people stop smoking

Silver acetate products (gum, lozenge, and spray) produce an unpleasant metallic taste when combined with cigarettes, so they are used as a form of aversion therapy for smoking. However, the review of trials found little evidence to show that silver acetate helps smokers quit. Any beneficial effect of silver acetate is likely to be very small, and less than the effect already proven for nicotine replacement therapy.

 

摘要

背景

Silver acetate用於戒菸

Silver acetate和菸品併用時，會產生令人不悅的味道而成為一嫌惡刺激。它在市面上以不同的形式銷售，透過將抽菸的衝動與不舒服的刺激配對，而達到降低抽菸衝動的目的。

目標

本回顧文獻的目的是確認silver acetate的相關產品(口香糖、錠劑、噴液)，於促進戒菸的效用。

搜尋策略

我們搜尋登錄於Cochrane Tobacco Addiction Group trials 的研究。最近一次的文獻搜尋是在2006年4月。

選擇標準

我們納入silver acetate用於戒菸的隨機分配試驗。其中個案復吸，至少出現在開始治療後六個月以上。

資料收集與分析

我們從副本取得關於個案類別、silver acetate 的劑量與劑型、結果的測量、隨機分配的方法、及是否完成追蹤等資料。主要結果的測量，當個案於試驗的起始點開始抽菸後，若於追蹤期間達六個月以上未抽菸，在生化學上被確認為停用菸品。若個案失去追蹤，在計算上，則被歸類為繼續吸菸者。我們適當地使用fixed effects model的metaanalysis來分析資料。

主要結論

在兩個個案被隨機分配到silver acetate組或安慰組的研究中，提供了長期追蹤的資料。在這些研究的一個研究中，多了一個分配到2毫克尼古丁嚼錠的比較組，而有三組。綜合這些資料，silver acetate組對安慰組的odds ratio是1.05(百分之95的信賴區間介於0.63至1.73)。

作者結論

因信賴區間太廣，對於silver acetate在促進戒菸上的特別效果，現有的研究僅顯示微小的證據。然而，在信賴區間的上限，其正面效果，約等同於增加4%的絕對戒菸率。所以silver acetate的任何效果，可能小於尼古丁取代療法。Silver acetate缺乏效果，可能導因於silver acetate 產生的不舒服刺激，造成的服藥順從度不佳所致。

翻譯人

本摘要由彰化基督教醫院鄭怡君翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

Silver acetate似乎不能幫助吸菸者戒菸。