ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Varenicline and Counseling for Patients Seeking to Stop Using Smokeless Tobacco May Lead to Higher Rates of Long-Term Abstinence Than Chairside Counseling Alone
Clinical Question In dental patients seeking to stop using smokeless tobacco, do medicinal therapies lead to higher rates of cessation than just chairside counseling in the dental office?
Clinical Bottom Line Based on the systematic reviews cited, there is evidence that a combination of varenicline (Chantix) and chairside counseling will lead to the highest rate of sustained tobacco abstinence. Two systematic reviews showed that there is a benefit to some type of tobacco cessation counseling. Among the studies that used varenicline as a medicinal therapy to aid in tobacco cessation, there was a clear increase in short-term abstinence; however, long-term abstinence had mixed results.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26501380Ebbert/201534 Clinical Trials; 16,000 participantsSystematic review of randomized trials
Key resultsEach included randomized trial had follow-up periods of at least 6 months. Two trials using varenicline as a medicinal therapy for smokeless tobacco cessation suggested it increases smokeless tobacco (ST) abstinence rates (risk ratio [RR] 1.34; 95% confidence interval (CI) 1.08 to 1.68; 507 participants). Two trials using bupropion as a medicinal therapy for tobacco cessation did not find an increase in ST abstinence rates (RR 0.89; 95% CI, 0.54 to 1.44; 293 participants). Seventeen trials with 12,394 participants tested various behavioral support interventions and found mixed results, with some finding a clear significant increase in abstinence rates and others with little or no significance.
#2) 22696348Carr/201214 Clinical TrialsSystematic review of randomized trials
Key resultsEach included randomized trial had a follow-up period of at least 6 months. Tobacco abstinence at follow-up between 6 and 24 months following dental interventions compared to usual care, no contact, or less treatment intensive controls found a ratio of 1.70 (95% CI, 1.36 to 2.11; I2 = 74%).
#3) 25646351Schwartz/20163 Randomized Clinical Trials; 744 participantsSystematic review of randomized trials
Key resultsEach controlled trial compared varenicline to placebo and measured the “7-day point prevalence of smokeless tobacco abstinence at the end of 12 and 26 weeks, respectively.” Individuals treated with varenicline had significantly higher 7-day point prevalence of smokeless tobacco abstinence at 12 weeks (48% vs. 33%; RR = 1.45, 95% CI = 1.22–1.72, p < .0001, I2 = 0%). This statistically significant difference, however, was not seen in the 26-week group (49% vs. 39%; RR = 1.38, 95% CI = 0.93–2.03, p = .11, I2 = 51%).
Evidence Search ("tobacco use cessation"[MeSH Terms] OR ("tobacco"[All Fields] AND "cessation"[All Fields]) OR "tobacco use cessation"[All Fields] OR ("smokeless"[All Fields] AND "tobacco"[All Fields] AND "cessation"[All Fields]) OR "smokeless tobacco cessation"[All Fields]) AND systematic[sb]
Comments on
The Evidence
Validity: The cited articles are large systematic reviews giving them high levels of credibility. Each review used randomized or pseudo-randomized clinical trials as a selection criteria. The Carr/2012 study reported evidence of heterogeneity in their included studies for ST cessation (I2 = 74%). The Schartz/2016 study reported evidence of heterogeneity in their included studies as well (I2 = 51%). Perspective: Systematic reviews have high levels of credibility as evidence. The second study found a moderate level of heterogeneity that was largely due to one of larger studies finding no benefit. However, the other five studies each indicated that chairside interventions for ST users were effective. More studies comparing the different methods of chairside counseling could help narrow down what type of counseling has the highest efficacy. The large amount of heterogeneity found at the 26-week mark for the third systematic review limits the interpretation of this aspect of the study. The differences in the results for the long-term efficacy of varenicline on smokeless tobacco cessation may warrant more research or a different inclusion/exclusion criteria for a systematic review.
Applicability Dentists treating patients seeking to stop using smokeless tobacco will be the most effective when a combination of varenicline and some type of counseling are used.
Specialty/Discipline (Public Health) (Oral Medicine/Pathology/Radiology) (General Dentistry)
Keywords Smokeless tobacco cessation, varenicline
ID# 3194
Date of submission: 04/05/2017spacer
E-mail luttrell@livemail.uthscsa.edu
Author Connor M. Luttrell
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Kevin M. Gureckis, DMD
Faculty mentor/Co-author e-mail Gureckis@uthscsa.edu
Basic Science Rationale
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