Article type
Abstract
Background
Acupuncture and related acupoint therapies have been widely used for smoking cessation. Some relevant systematic reviews (SRs) have been published. There is a need to summarize and update the evidence.
Objective
An overview and updated meta-analysis was conducted to provide an evidence profile of acupuncture and related acupoint therapies for smoking cessation to inform practice and decision-making.
Methods
Eight databases were searched from their inception to December 2023. SRs, any randomized controlled trials (RCTs) comparing acupuncture and acupoint stimulation therapies with sham acupuncture, pharmacotherapy, behavioral therapy, or no treatment were included. The primary outcome was abstinence rate. AMSTAR-2 was employed to assess the quality of SRs. Updated meta-analysis was conducted based on SRs and unevaluated RCTs. Data were synthesized using risk ratios (RR) with 95% confidence intervals (CI). GRADE approach was employed to assess the certainty of the updated evidence.
Results
Thirteen SRs, and 20 RCTs outside of the SRs were identified. The SRs were of low or very low quality by AMSTAR-2. Sixteen (80%) RCTs were of high risk of performance bias. Eight acupuncture and related acupoint therapies were involved, including filiform needle acupuncture, acupressure, Chinese herbal medicine external use at acupoints, transcutaneous electrical acupoint stimulation (TEAS), laser acupuncture, intradermal needle, fire acupuncture, and acupoint catgut embedding. For short-term (≤ 6 months) abstinence rate. Most of SRs suggested that filiform needle acupuncture, acupressure had better effect than sham acupuncture, but the findings were inconsistent. The updated meta-analysis also suggested that filiform needle acupuncture was more effective than sham acupuncture (RR 1.44, 95% CI [1.02, 2.02]; I2 = 66%; low certainty; 9 RCTs, n=1358). Filiform needle acupuncture combined with auricular acupressure was comparable to nicotine patches (RR, 0.99, 95%CI [0.74, 1.32] low certainty; 6 RCTs, n= 524). Auricular acupressure was superior to counseling (RR 1.46, 95% CI [1.14, 1.87]; I2 =5%; low certainty; 8 RCTs, n=595). No serious adverse events were reported in these SRs or RCTs.
Conclusions
Low certainty evidence suggests that filiform needle acupuncture, and auricular acupressure appear to be safe and effective in achieving short-term smoking cessation. However, long-term follow up data are warranted.
Acupuncture and related acupoint therapies have been widely used for smoking cessation. Some relevant systematic reviews (SRs) have been published. There is a need to summarize and update the evidence.
Objective
An overview and updated meta-analysis was conducted to provide an evidence profile of acupuncture and related acupoint therapies for smoking cessation to inform practice and decision-making.
Methods
Eight databases were searched from their inception to December 2023. SRs, any randomized controlled trials (RCTs) comparing acupuncture and acupoint stimulation therapies with sham acupuncture, pharmacotherapy, behavioral therapy, or no treatment were included. The primary outcome was abstinence rate. AMSTAR-2 was employed to assess the quality of SRs. Updated meta-analysis was conducted based on SRs and unevaluated RCTs. Data were synthesized using risk ratios (RR) with 95% confidence intervals (CI). GRADE approach was employed to assess the certainty of the updated evidence.
Results
Thirteen SRs, and 20 RCTs outside of the SRs were identified. The SRs were of low or very low quality by AMSTAR-2. Sixteen (80%) RCTs were of high risk of performance bias. Eight acupuncture and related acupoint therapies were involved, including filiform needle acupuncture, acupressure, Chinese herbal medicine external use at acupoints, transcutaneous electrical acupoint stimulation (TEAS), laser acupuncture, intradermal needle, fire acupuncture, and acupoint catgut embedding. For short-term (≤ 6 months) abstinence rate. Most of SRs suggested that filiform needle acupuncture, acupressure had better effect than sham acupuncture, but the findings were inconsistent. The updated meta-analysis also suggested that filiform needle acupuncture was more effective than sham acupuncture (RR 1.44, 95% CI [1.02, 2.02]; I2 = 66%; low certainty; 9 RCTs, n=1358). Filiform needle acupuncture combined with auricular acupressure was comparable to nicotine patches (RR, 0.99, 95%CI [0.74, 1.32] low certainty; 6 RCTs, n= 524). Auricular acupressure was superior to counseling (RR 1.46, 95% CI [1.14, 1.87]; I2 =5%; low certainty; 8 RCTs, n=595). No serious adverse events were reported in these SRs or RCTs.
Conclusions
Low certainty evidence suggests that filiform needle acupuncture, and auricular acupressure appear to be safe and effective in achieving short-term smoking cessation. However, long-term follow up data are warranted.